Di Castelnuovo Augusto, Bonaccio Marialaura, Costanzo Simona, De Curtis Amalia, Magnacca Sara, Persichillo Mariarosaria, Panzera Teresa, Bracone Francesca, Pignatelli Pasquale, Carnevale Roberto, Cerletti Chiara, Donati Maria Benedetta, de Gaetano Giovanni, Iacoviello Licia, Violi Francesco
Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.
Department of Clinical Internal, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
EClinicalMedicine. 2024 May 8;72:102627. doi: 10.1016/j.eclinm.2024.102627. eCollection 2024 Jun.
Serum albumin is inversely associated with overall mortality, but its association with specific causes of death remains uncertain. This study aims to investigate whether hypoalbuminemia, defined as serum albumin levels ≤35 g/L, is associated with mortality specifically attributed to cancer and/or vascular diseases.
Serum albumin levels were measured in the population-based, prospective cohort of the Moli-sani study, established between 2005 and 2010. Hypoalbuminemia was defined as serum albumin levels ≤35 g/L. Cause-specific mortality was assessed using the validated Italian mortality registry and coded according to the International Classification of Diseases, Revision 9. Over a median follow-up period of 13.1 years, the relationship between serum albumin and mortality, adjusted for covariates, was investigated using competing-risk survival analysis.
The analysed cohort comprised 17,930 individuals aged ≥35 years, of whom 8445 were men (47.1%). The mean age was 54 years (standard deviation (SD) = 11 years), with 3299 individuals (18.4%) aged older than 65 years. All participants had C-reactive protein levels <10 mg/L and no history of liver, renal, cardiovascular, or cancer disease. Hypoalbuminemia was found in 406 individuals (2.3%). The study documented a total of 1428 deaths, with 574 attributed to cancer and 464 to vascular causes. Hypoalbuminemia was independently associated with mortality when compared to serum albumin >40 g/L (Hazard Ratio (HR) = 1.61, 95% Confidence Interval: 1.21-2.13). A decrease of 1-SD in serum albumin levels corresponded to HR of 1.16 (1.09-1.22), 1.16 (1.05-1.28), and 1.13 (1.03-1.23) for total, vascular and cancer mortality, respectively. Upon stratifying by age, hypoalbuminemia was associated with total mortality solely in those aged ≥65 years (HR = 1.83; 1.33-2.50) but not in the <65 years group (HR = 1.03; 0.53-2.00; P < 0.0001 for difference). Similar age-related patterns emerged for vascular death (per 1-SD decrease HR = 1.19; 1.07-1.33 in individuals ≥65 years and HR = 1.05; 0.86-1.29 in individuals <65 years) and cancer mortality (HR = 1.15; 1.02-1.30; ≥65 years and HR = 1.08; 0.96-1.23; <65 years).
Individuals ≥65 years old with serum albumin levels ≤35 g/L are at higher risk of total, cancer, and vascular mortality.
This paper was developed within the project funded by Next Generation EU-"Age-It - Ageing well in an ageing society" project (PE0000015), National Recovery and Resilience Plan (NRRP)-PE8-Mission 4, C2, Intervention 1.3.
血清白蛋白与总死亡率呈负相关，但其与特定死因的关联仍不明确。本研究旨在调查血清白蛋白水平≤35 g/L定义的低白蛋白血症是否与癌症和/或血管疾病导致的死亡率相关。
在2005年至2010年间建立的基于人群的前瞻性莫利萨尼研究队列中测量血清白蛋白水平。低白蛋白血症定义为血清白蛋白水平≤35 g/L。使用经过验证的意大利死亡率登记处评估特定病因死亡率，并根据国际疾病分类第9版进行编码。在13.1年的中位随访期内，使用竞争风险生存分析研究调整协变量后血清白蛋白与死亡率之间的关系。
分析的队列包括17930名年龄≥35岁的个体，其中8445名是男性（47.1%）。平均年龄为54岁（标准差（SD）=11岁），3299名个体（18.4%）年龄超过65岁。所有参与者的C反应蛋白水平<10 mg/L，且无肝脏、肾脏、心血管或癌症疾病史。406名个体（2.3%）存在低白蛋白血症。该研究共记录了1428例死亡，其中574例归因于癌症，464例归因于血管原因。与血清白蛋白>40 g/L相比，低白蛋白血症与死亡率独立相关（风险比（HR）=1.61，95%置信区间：1.21-2.13）。血清白蛋白水平每降低1个标准差，总死亡率、血管死亡率和癌症死亡率的HR分别为1.16（1.09-1.22）、1.16（1.05-1.28）和1.13（1.03-1.23）。按年龄分层后，低白蛋白血症仅与≥65岁人群的总死亡率相关（HR=1.83；1.33-2.50），而与<65岁人群无关（HR=1.03；0.53-2.00；差异P<0.0001）。血管死亡和癌症死亡率也出现了类似的年龄相关模式（血清白蛋白每降低1个标准差，≥65岁个体的HR=1.19；1.07-1.33，<65岁个体的HR=1.05；0.86-1.29；癌症死亡率方面，≥65岁个体的HR=1.15；1.02-1.30，<65岁个体的HR=1.08；0.96-1.23）。
血清白蛋白水平≤35 g/L的≥65岁个体总死亡率、癌症死亡率和血管死亡率风险更高。
本文是在由下一代欧盟资助的项目——“Age-It - 在老龄化社会中健康老龄化”项目（PE0000015）、国家复苏与韧性计划（NRRP）-PE8-任务4、C2、干预措施1.3中完成的。
