Low serum albumin as a risk factor for infection-related in-hospital death among hemodialysis patients hospitalized on suspicion of infectious disease: a Japanese multicenter retrospective cohort study

Abstract

Background: Serum albumin is a marker of nourishment and inflammation. Although hypoalbuminemia in hemodialysis patients is reported as a risk factor for poor prognosis, few studies describe its effects on infectious diseases specifically. This study aimed to examine the relationship between the serum albumin level on admission and infection-related in-hospital death among hemodialysis patients. Methods: This was a multicenter retrospective observational study that was undertaken in Japan. We reviewed the medical records of 507 hemodialysis patients aged > 18 years, whose blood cultures were obtained based on suspicion of infectious disease, and who were managed at seven Japanese tertiary dialysis units from August 2011 to July 2013. The outcome measure was infection-related in-hospital death. Multivariate logistic regression models adjusted for age, sex, the dialysis vintage, diabetes mellitus, bacteremia, and log C-reactive protein levels were used for the statistical analysis. Results: Four hundred patients were analyzed and allocated to three groups based on their serum albumin levels: marked hypoalbuminemia (< 2.5 mg/dL), mild hypoalbuminemia (≤ 2.5-< 3.5 mg/dL), and normal albumin levels (≤ 3.5 mg/dL). The infection-related in-hospital death rates were 22.9% (n = 11), 12.5% (n = 25), and 4.6% (n = 7), respectively. The multivariate logistic regression models determined that a low serum albumin level was an independent risk factor for infection-related in-hospital death (odds ratio 0.35, 95% confidence interval 0.18-0.66). Conclusions: A low serum albumin level strongly predicts infection-related in-hospital death in hemodialysis patients hospitalized on suspicion of infection. Like those with bacteremia or diabetes mellitus, hemodialysis patients with hypoalbuminemia require careful management of their infections.

Comorbidities, clinical signs and symptoms, laboratory findings, imaging features, treatment strategies, and outcomes in adult and pediatric patients with COVID-19: A systematic review and meta-analysis

“…However, exaggerated synthesis of interleukin 6 can lead to an acute, severe systemic inflammatory response syndrome (SIRS) known as ‘cytokine storm’ [ 192 ]. In addition to SIRS, hypoalbuminemia and lymphopenia were previously shown to be associated with increased odds of severe infection and infection-related death [ [193] , [194] , [195] ]. Complications were very common amongst patients with severe COVID-19 disease (over 50%) and non-survivors (more than two thirds).…”

The impact of procalcitonin to C-reactive protein ratio (PCR) kinetics as a predictor of mortality in nosocomial bloodstream infections

“…Albumin (ALB) tends to decrease in levels during acute infections and is a strong indicator of outcome in infectious diseases. The relationship between low serum albumin level and high mortality has been reported in several studies [15,16].…”

Infectious Complications in Patients with Primary Glomerulonephritis over 10 Years: A Single-Center Experience in Turkey

“…It could be a risk factor by affecting the free fraction of the drug interacting with the drug receptor [29]. With that being said, Minatoguchi et al’s [30] findings showed that the serum albumin level was a significant risk factor for infection-related in-hospital death among hemodialysis patients.…”