Department of General Surgery and Surgical Specialty, Sapienza University of Rome, Rome, Italy; Department of Infectious Disease, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy.
Department of General Surgery and Surgical Specialty, Sapienza University of Rome, Rome, Italy.
J Thromb Haemost. 2024 Oct;22(10):2823-2833. doi: 10.1016/j.jtha.2024.06.018. Epub 2024 Jul 4.
Albumin has antiplatelet and anticoagulant functions. Hypoalbuminemia, as defined by serum values of <3.5 g/dL, is associated with arterial thrombosis; its impact on venous thromboembolism (VTE) is unclear.
The objective of this meta-analysis is to assess the VTE risk in patients with hypoalbuminemia.
MEDLINE and EMBASE were searched up to January 2024 for observational studies and randomized trials reporting data of interest. Primary outcome was the risk of VTE, while secondary outcomes were myocardial infarction and stroke risk in patients with hypoalbuminemia versus those without hypoalbuminemia. The risk of bias was evaluated using Newcastle-Ottawa scale and Cochrane tool. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated in a random-effects model.
Forty-three studies for a total of 2 531 091 patients (39 738 medical and 2 491 353 surgical) were included in primary analysis; 79.1% of the studies used 3.5 g/dL cut-off value for hypoalbuminemia definition. Follow-up duration was 30 days in 60.5% of studies. Patients with hypoalbuminemia had a higher risk of VTE (RR, 1.88; 95% CI, 1.66-2.13). RRs were similar in both medical (RR, 1.87; 95% CI, 1.53-2.27) and surgical patients (RR, 1.87; 95% CI, 1.61-2.16) and in patients with (RR, 1.86; 95% CI, 1.66-2.10) and without cancer (RR, 1.89; 95% CI, 1.47-2.44). Risk of myocardial infarction (RR, 1.88; 95% CI, 1.54-2.31) and stroke (RR, 1.77; 95% CI, 1.26-2.48) was higher in patients with hypoalbuminemia.
Hypoalbuminemia is a risk factor for VTE in both medical and surgical patients irrespective of cancer coexistence. Serum albumin analysis may represent a simple and cheap tool to identify patients at VTE risk.
白蛋白具有抗血小板和抗凝作用。血清值<3.5g/dL 定义的低蛋白血症与动脉血栓形成有关；其对静脉血栓栓塞症（VTE）的影响尚不清楚。
本荟萃分析旨在评估低蛋白血症患者的 VTE 风险。
检索 MEDLINE 和 EMBASE 数据库，以获取截至 2024 年 1 月报告相关数据的观察性研究和随机试验。主要结局是 VTE 风险，次要结局是低蛋白血症患者与无低蛋白血症患者的心肌梗死和卒中风险。使用纽卡斯尔-渥太华量表和 Cochrane 工具评估偏倚风险。采用随机效应模型计算风险比（RR）及其 95%置信区间（CI）。
共有 43 项研究（共纳入 2531091 例患者，其中 39738 例为内科患者，2491353 例为外科患者）纳入主要分析；79.1%的研究采用 3.5g/dL 作为低蛋白血症定义的切点值。60.5%的研究随访时间为 30 天。低蛋白血症患者 VTE 风险较高（RR，1.88；95%CI，1.66-2.13）。内科患者（RR，1.87；95%CI，1.53-2.27）和外科患者（RR，1.87；95%CI，1.61-2.16）以及合并癌症患者（RR，1.86；95%CI，1.66-2.10）和无癌症患者（RR，1.89；95%CI，1.47-2.44）的 RR 相似。低蛋白血症患者心肌梗死（RR，1.88；95%CI，1.54-2.31）和卒中（RR，1.77；95%CI，1.26-2.48）风险较高。
低蛋白血症是内科和外科患者 VTE 的危险因素，无论是否合并癌症。血清白蛋白分析可能是识别 VTE 风险患者的一种简单、廉价的工具。
