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

Abstract

Community-acquired bacteraemia patients (n = 2472), Denmark, 2000-2008. Albumin, C-reactive protein (CRP) and haemoglobin (Hb) measured 2000-2010. We assessed daily mean levels of albumin, CRP and Hb from 30 days before to 30 days after bacteraemia and correlations between albumin vs. CRP and albumin vs. Hb. In linear regression models, we evaluated the contribution of CRP, Hb, chronic and acute variables to the albumin level variations. The mean albumin level (33.6 g/l) was steady before day 1, declined to 29.3 g/l on day 1 with little increase afterward. The mean CRP increased from day -5, peaked on day 1 and declined thereafter. The mean Hb level was fairly constant during days -30/30. Albumin was inversely (R range, - 0.18/-0.47, P < 10-4) correlated with the CRP level and positively (R = 0.17-0.46, P < 10-4) correlated with the HB level. In most models, CRP was the first variable that contributed to the albumin variations, 34-70% of the full model. The sudden decrease of albumin levels, without sudden fluctuations of CRP or Hb, indicated that hypoalbuminaemia was a marker of trans-capillary leakage.

Longitudinal trajectory patterns of plasma albumin and C-reactive protein levels around diagnosis, relapse, bacteraemia, and death of acute myeloid leukaemia patients

“…In the present study, the CRP and PA trajectories around the bacteraemic episodes did not deviate from what we have reported for 2472 adult communityacquired bacteraemia patients [27]. This indicates that the pathogenesis related to CRP and PA changes around a bacteraemic episode probably does not differ in relation to the patient group or the degree of immunosuppression.…”

“…A number of CRP results were recorded as < 10 mg/L (854/60,209 specimens [1.4%]) or < 5 mg/L (1842 specimens [3.1%]). We therefore randomly re-allocated all CRP levels < 10 mg/L to range from 0 through 9 mg/L, based on the distribution from 10 through 19 mg/L [27]. The same principle was used for CRP levels < 5 mg/L (range 0-4 mg/L, based on the 10-14 mg/L distribution).…”

“…PA levels were normally distributed, whereas CRP levels were right skewed. In accordance with a previous study [27], longitudinal trajectories did not differ according to whether medians (interquartile ranges) or means (95% confidence intervals [CIs]) were used.…”

“…Longitudinal studies elucidate whether an abnormal level of the biomarker reflects an acute or a chronic ailment. We recently published longitudinal assessment studies of CRP and PA levels before and after community-acquired bacteraemia [27,28]. Some of the main findings in these studies were the high inverse correlations between CRP and PA levels and changes.…”

C-reactive protein and albumin kinetics before community-acquired bloodstream infections – a Danish population-based cohort study

“…As already pointed out by our group [8], CRP and PA levels were not within the normal range before the CA-BSI. The elevated CRP concentration, >60 mg/l, is much higher than the <10 mg/l found in healthy Danes [13,14].…”