Albumin as a prognostic marker for ulcerative colitis

Abstract

AIMTo evaluate the role of albumin at the time of ulcerative colitis (UC) diagnosis in predicting the clinical course of disease.METHODSNationwide cohort of patients with newly diagnosed UC in the Veterans Affairs health care system was identified and divided into two categories: hypoalbuminemia (i.e., ≤ 3.5 gm/dL) or normal albumin levels (i.e., > 3.5 gm/dL) at the time of UC diagnosis. The exposure of interest was presence of hypoalbuminemia defined as albumin level ≤ 3.5 g/dL at the time of UC diagnosis. Patients were then followed over time to identify the use of ≥ 2 courses of corticosteroids (CS), thiopurines, anti-TNF medications and requirement of colectomy for UC management.RESULTSThe eligible study cohort included 802 patients, but 92 (11.4%) patients did not have their albumin levels checked at the time of UC diagnosis, and they were excluded. A total of 710 patients, who had albumin levels checked at time of UC diagnosis, were included in our study. Amongst them, 536 patients had a normal albumin level and 174 patients had hypoalbuminemia. Patients with hypoalbuminemia at diagnosis had a higher likelihood of ≥ 2 courses of CS use (adjusted HR = 1.7, 95%CI: 1.3-2.3), higher likelihood of thiopurine or anti- TNF use (adjusted HR = 1.72, 95%CI: 1.23-2.40) than patients with normal albumin level at diagnosis. There was a trend of higher likelihood of colectomy in hypoalbuminemic patients, but it was not statistically significant (Adjusted HR = 1.7, 95%CI: 0.90-3.25).CONCLUSIONHypoalbuminemia at disease diagnosis can serve as a prognostic marker to predict the clinical course of UC at the time of diagnosis.

Azathioprine Is Useful for Maintaining Long-term Remission Induced by Tacrolimus for the Treatment of Ulcerative Colitis: An Inverse Probability of a Treatment Weighing Analysis

“…Candidate factors associated with the long-term outcomes of tacrolimus therapy in the multivariate Cox regression model were the sex (14), age at the diagnosis (14), concomitant IM, steroid dependency, albumin (15), and disease location (16), These factors were previously reported to be associated with the clinical course of UC. Interactions among these 6 factors in the multivariate analysis revealed concomitant IM to be an independent protective factor for relapse (adjusted HR: 0.35, 95% CI: 0.16-0.78, p=0.01), while the other 5 factors were not significantly associated with increased risks of clinical relapse (Table 2).…”

Reductively modified albumin attenuates DSS-Induced mouse colitis through rebalancing systemic redox state

“…Using this model, we demonstrated that the administration of r-Alb potently prevented the onset and progression of the disease. In patients with colitis, the amount of plasma Alb is decreased because of the chronic inflammation in the intestinal tract, and the antioxidative capacity of Alb is also weakened due to the oxidative modification [ 22 , [31] , [32] , [33] ]. As a bioproduct, Alb is used in many clinical situations.…”

“…In both experimental model and IBD patients, the serum level of Alb is reported to be decreased, whereas the oxidized Alb is increased [ 22 , [31] , [32] , [33] ]. Furthermore, the altered Alb is closely correlated with inflammatory activity and has been proposed as prognostic marker of UC diagnosis [ 31 ]. In these backgrounds, we, therefore, hypothesized that the supplement of Alb, especially the reduced Alb, could have a beneficial therapeutic effect on IBD.…”

Diet and inflammatory bowel disease: The Asian Working Group guidelines

“…In patients who have hypoalbuminemia, though feeding is an important supportive measure, nutritional support alone is very unlikely to restore low albumin levels. The evidence to support the use of intravenous albumin is poor and underlying sepsis and inflammation should be adequately controlled [ 208 ]. In elective surgery, the early/enhanced recovery after surgery protocol should be followed in the perioperative period …”