Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.
Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
JPEN J Parenter Enteral Nutr. 2023 Mar;47(3):408-419. doi: 10.1002/jpen.2470. Epub 2023 Jan 27.
Because of the shorter half-life as compared with albumin, serum prealbumin concentrations have been proposed to be useful nutrition biomarkers for the assessment of patients at nutrition risk. In a post hoc analysis of patients at nutrition risk from a randomized controlled nutrition trial, we tested the hypothesis that (1) prealbumin is associated with higher all-cause 180-day mortality rates and that (2) individualized nutrition support compared with usual-care nutrition more effectively improves survival at 30 days in patients with low prealbumin levels compared with patients with normal prealbumin levels.
We performed a prespecified cohort study in patients included in the pragmatic, Swiss, multicenter randomized controlled EFFORT trial comparing the effects of individualized nutrition support with usual care. We studied low prealbumin concentrations (<0.17 g/L) in a subgroup of 517 patients from one participating center.
A total of 306 (59.2%) patients (mean age 71.9 years, 53.6% men) had low admission prealbumin levels (<0.17 g/L). There was a significant association between low prealbumin levels and mortality at 180 days (115/306 [37.6%] vs 47/211 [22.3%], fully adjusted hazard ratio [HR]=1.59, 95% CI 1.11-2.28; P = 0.011). Prealbumin levels significantly improved the prognostic value of the Nutritional Risk Screening total score regarding mortality prediction at short- and long-term. The difference in mortality between patients receiving individualized nutrition support and usual-care nutrition was similar for patients with low prealbumin levels compared with patients with normal prealbumin levels (HR=0.90 [95% CI=0.51-1.59] vs HR=0.88 [95% CI=0.35-2.23]) with no evidence for interaction (P = 0.823).
Among medical inpatients at nutrition risk, low admission prealbumin levels correlated with different nutrition markers and higher mortality risk, but patients with low or high prealbumin levels had a similar benefit from nutrition support. Further studies should identify nutrition markers that help further personalize nutrition interventions.
与白蛋白相比，血清前白蛋白的半衰期较短，因此被提议作为评估营养风险患者的有用营养生物标志物。在一项针对营养风险随机对照营养试验的事后分析中，我们检验了以下假设：（1）前白蛋白与更高的全因 180 天死亡率相关；（2）与常规护理营养相比，个体化营养支持更有效地改善低前白蛋白水平患者的 30 天生存率，而与正常前白蛋白水平患者相比。
我们在一项实用的、瑞士的、多中心随机对照 EFFORT 试验中进行了一项预设队列研究，比较了个体化营养支持与常规护理的效果。我们研究了来自一个参与中心的 517 名患者中的低前白蛋白浓度（<0.17 g/L）亚组。
共有 306 名（59.2%）患者（平均年龄 71.9 岁，53.6%为男性）入院时前白蛋白水平较低（<0.17 g/L）。低前白蛋白水平与 180 天死亡率之间存在显著关联（115/306 [37.6%] 与 47/211 [22.3%]，完全调整后的风险比 [HR]=1.59，95%置信区间 [CI] 为 1.11-2.28；P=0.011）。前白蛋白水平显著提高了营养风险筛查总评分对短期和长期死亡率预测的预后价值。与正常前白蛋白水平的患者相比，接受个体化营养支持和常规护理营养的患者之间的死亡率差异在低前白蛋白水平患者中相似（HR=0.90 [95%CI=0.51-1.59] 与 HR=0.88 [95%CI=0.35-2.23]），无交互作用证据（P=0.823）。
在有营养风险的住院患者中，入院时低前白蛋白水平与不同的营养标志物和更高的死亡风险相关，但低或高前白蛋白水平的患者从营养支持中获益相似。进一步的研究应确定有助于进一步个体化营养干预的营养标志物。
