Changes in serum albumin concentrations over 7 days in medical inpatients with and without nutritional support. A secondary post-hoc analysis of a randomized clinical trial

Abstract

Background Serum albumin concentrations are frequently used to monitor nutritional therapy in the hospital setting but supporting studies are largely lacking. Within this secondary analysis of a randomized nutritional trial (EFFORT), we assessed whether nutritional support affects short-term changes in serum albumin concentrations and whether an increase in albumin concentration has prognostic implications regarding clinical outcome and response to treatment. Methods We analyzed patients with available serum albumin concentrations at baseline and day 7 included in EFFORT, a Swiss-wide multicenter randomized clinical trial that compared individualized nutritional therapy with usual hospital food (control group). Results Albumin concentrations increased in 320 of 763 (41.9%) included patients (mean age 73.3 years (SD ± 12.9), 53.6% males) with no difference between patients receiving nutritional support and controls. Compared with patients that showed a decrease in albumin concentrations over 7 days, those with an increase had a lower 180-day mortality [74/320 (23.1%) vs. 158/443 (35.7%); adjusted odds ratio 0.63, 95% CI 0.44 to 0.90; p = 0.012] and a shorter length of hospital stay [11.2 ± 7.3 vs. 8.8 ± 5.6 days, adjusted difference −2.2 days (95%CI −3.1 to −1.2)]. Patients with and without a decrease over 7 days had a similar response to nutritional support. Conclusion Results from this secondary analysis indicate that nutritional support did not increase short-term concentrations of albumin over 7 days, and changes in albumin did not correlate with response to nutritional interventions. However, an increase in albumin concentrations possibly mirroring resolution of inflammation was associated with better clinical outcomes. Repeated in-hospital albumin measurements in the short-term is, thus, not indicated for monitoring of patients receiving nutritional support but provides prognostic information. Trail Registration ClinicalTrials.gov Identifier: NCT02517476.

Serum Albumin and Post-Stroke Outcomes: Analysis of UK Regional Registry Data, Systematic Review, and Meta-Analysis

“…Whilst current evidence does not support the use of IV albumin treatment, an important modifiable target to increase albumin levels is nutritional intervention. Randomised control trials investigating nutritional intervention remain limited in patients with AIS [25,26], potentially driven by a lack of consensus on the benefits and optimal use of nutritional support in medical patients with acute and severe illness [27,28]. A small randomised controlled trial (RCT) recently showed improved albumin levels in patients with HF who received oral branched-chain amino acids (BCAAs) granules added to standard therapy for 28 days until discharge compared to nine controls [29].…”

“…A RCT in 2020 demonstrates no rise in albumin after supplementation with whey protein in patients who have suffered a stroke [26]. A secondary post hoc analysis of the EFFORT RCT, concluded that in the short-term, a rise in serum albumin levels occurred regardless of nutritional support [27]. Further studies suggest that albumin levels may not depend on nutritional support or albumin treatment but rather the resolution of disease and inflammation [28].…”

Immunonutrition effects in patients with cancer undergoing chemotherapy: an integrative review of clinical trials

“…O mesmo efeito não foi verificado em relação à albumina provavelmente porque a intervenção durou 10 dias, e a meia-vida da albumina é de 19 dias. Esse resultado é compatível com outros, que indicam que intervenções nutricionais não aumentam as concentrações de albumina em curto prazo, (BOESIGER et al, 2023) porém são suficientes para aumentar os valores de pré-albumina (DI RENZO et al, 2019).…”

Perioperative and post-hospital whole-course nutrition management in patients with pancreatoduodenectomy – a single-center prospective randomized controlled trial

“…Inflammation caused by primary diseases and surgical injury can affect the effectiveness of nutritional support, and changes in traditional nutritional indicators are not sensitive or comprehensive enough to reflect short-term improvements in nutritional status. Albumin, one of the traditional indicators, is considered an inflammation marker rather than a nutritional marker 32 , 33 . In recent years, several high-quality studies have defined the primary endpoint for determining the effectiveness of nutritional intervention as whether it can improve perioperative outcomes, mainly mortality in non-surgical patients and the incidence of postoperative infection complications in surgical patients 7 , 34 .…”