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Low serum albumin levels predict short‐ and long‐term mortality risk in patients hospitalised to general surgery wards
Author(s) -
Akirov Amit,
Gorshtein Alexander,
AdlerCohen Chagit,
Steinmetz Tali,
Shochat Tzipora,
Shimon Ilan
Publication year - 2020
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.14708
Subject(s) - medicine , albumin , serum albumin , prospective cohort study , hypoalbuminemia , gastroenterology , pediatrics , surgery
Background Previous studies have reported conflicting results on the association between hypoalbuminaemia and morbidity and mortality in hospitalised patients. Aims To investigate the association of albumin levels on admission and change in levels during hospitalisation of patients in general surgery wards with hospitalisation outcomes. Methods Historical prospective data of patients hospitalised between January 2011 and December 2017. Albumin levels were classified as follows: marked hypoalbuminaemia (<2.5 mg/dL), mild hypoalbuminaemia (2.5–3.5 mg/dL), normal albumin (3.5–4.5 mg/dL) and hyperalbuminaemia (>4.5 mg/dL). Main outcomes were length of hospitalisation, 30‐days and long‐term mortality. Results The cohort included 17 930 patients (mean age 58 ± 20 years, 49% male). Most had normal albumin levels on admission ( n = 11 087, 62%), 16% had mild hypoalbuminaemia ( n = 2824) and 3% had marked hypoalbuminaemia ( n = 529). Hyperalbuminaemia on admission was evident in 20% of the patients ( n = 3490). Follow‐up time was up to 7.2 years (median ± SD = 3 ± 2 years). Compared to 30‐day mortality with normal albumin on admission (2%), mortality was higher with mild (9%) and marked hypoalbuminaemia (22%) and lower with hyperalbuminaemia (0.4%). The mortality rate at the end of follow up was 14% with normal albumin levels, and 35% and 58% with mild and marked hypoalbuminaemia respectively. Patients with hyperalbuminaemia on admission and before discharge had the best short‐ and long‐term survival. This pattern was similar when analysed separately in different age groups. In patients with hypoalbuminaemia on admission, normalisation of albumin levels before discharge was associated with lower short‐ (12% vs 1%) and long‐term mortality risk (42% vs 17%). Conclusions Low albumin levels on admission to general surgery wards are associated with increased short‐ and long‐term mortality. Normalisation of albumin levels before discharge was associated with lower mortality, compared to hypoalbuminaemia before discharge.