Association between Hypoalbuminaemia and Mortality in Patients with Community-Acquired Bacteraemia Is Primarily Related to Acute Disorders

Abstract

We sought to investigate whether hypoalbuminaemia was mainly caused by acute or chronic factors in patients with community-acquired bacteraemia. In this population-based study, we considered 1844 adult cases of community-acquired bacteraemia that occurred in Funen, Denmark between 2000 and 2008. We used a stepwise prognostic predisposition-insult-response-organ dysfunction (PIRO) logistic regression model by initially including age and comorbidity, then added bacterial species, and finally sepsis severity. The models were furthermore analysed using receiver operating characteristic (ROC) curves. Outcomes comprised mortality incidence on days 0–30 and 31–365 after the bacteraemia episode. Each step was performed with and without baseline albumin level measured on the date of bacteraemia. In 422 patients, their latest albumin measurement taken 8–30 days before the date of bacteraemia was also used in the analysis together with the baseline albumin level. For each decrease of 1g/L in plasma albumin level, the odds ratios (95% confidence intervals) of mortality in the period of 0–30 days after bacteraemia were 0.86 (0.84–0.88) in both predisposition (P) and predisposition-insult (PI) models and 0.87 (0.85–0.89) in the full PIRO-model. The AUC values were 0.78 and 0.66 for mortality in the period of 0–30 days in the model comprising only predisposition factors with and without albumin levels added as a factor, respectively. The AUC values in the full PIRO-model were 0.81 and 0.73 with and without consideration of albumin levels, respectively. A higher proportion of patients died within 30 days if there was a decrease in the albumin level between days 8 and 30 before bacteraemia and the actual bacteraemia date. A single plasma albumin measurement on the bacteraemia date was a better prognostic predictor of short-term mortality than the sepsis severity score.

Hypoalbuminaemia as a marker of trans-capillary leakage in community-acquired bacteraemia patients

“…Our results indicate that the sudden decline in the albumin level when bacteraemia occurs is mainly due to trans-capillary leakage, reflecting the magnitude of the microcirculation impairment. These results, together with our previous findings that the albumin level is a strong prognostic predictor [23], are clinically important. If possible for the specific patient, clinicians should focus on the day-to-day decline of albumin levels rather than albumin levels per se as such declines reflect the severity of the septic condition, which, in contrast to chronic conditions, is treatable in the acute setting.…”

Trends in admission serum albumin and mortality in patients with hospital readmission

“…To date, several studies have confirmed the relationship between hypoalbuminemia and delayed mortality . We found that this association is independent of other coexisting morbidities as has been recently shown in two different studies that tested the association between hypoalbuminemia, short‐term and long‐term mortality, the authors found that the correlation of hypoalbuminemia with mortality did not change after adjusting for chronic or acute conditions.…”

Real-Life Data Patterns of C-Reactive Protein and Albumin Level Trajectories Around Bacteremia

“…The study cohort has been described previously [4][5][6][7]. In brief, it comprised all adult (>14 y) persons residing in the Funen County with their first-time community-acquired bacteraemia in 2000-2008, and CRP measured from two days before until the day after the bacteraemia date (date of draw of blood culture [BC]; if date of draw was missing, date of receipt of BC [never missing]).…”

“…We used logistic regression analyses with odds ratios (ORs) and 95% CIs, with mortality within 30 days from the bacteraemia date as the outcome. Initially, we adopted the predispositioninsult-response-organ dysfunction (PIRO) model [9] used previously [6]. We included age, gender,…”

“…We have previously reported the prognostic prediction of one-time levels of serum Creactive protein (CRP) [4,5] and plasma albumin (PA) [6] in community-acquired bacteraemia patients from a geographically well-defined Danish region. In the same cohort, we recently found that levels of CRP and PA were inversely correlated before, during and after the bacteraemic episode, even after adjustment for other clinically important cofounders such as sepsis criteria or organ dysfunctions [7].…”