Serum albumin, prealbumin, and ischemia-modified albumin levels in patients with ANCA-associated vasculitis: A prospective cohort study

Abstract

Objectives Acute phase reactants (APRs) are proteins altered by inflammation and are regarded as surrogate markers representing inflammatory status. This study evaluated changes of albumin (Alb), prealbumin (Palb), and ischemia-modified albumin (IMA) in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) in response to alterations in disease activity and the correlation between disease activity and Alb, Palb, and IMA. Methods Fifty-nine patients with AAV registered in the prospective SHAVE cohort, who had available serial blood samples at least three months apart were included (indicated as pre and post). Correlation analysis and linear regression were carried out to determine the relationship between continuous variables. Alb, Palb, and IMA levels in 40 healthy controls (HCs) were compared with patients with AAV. Results Comparison of Alb, Palb, and IMA levels in HCs and in patients at initial (pre) and follow-up (post) time points revealed that Alb levels significantly increased following the improvement of disease activity and were comparable between HCs and patients at follow-up (post). Meanwhile, there was no significant difference noted in Palb and IMA levels after the decrease of disease activity. While initial (pre) Alb and Palb were significantly associated with BVAS, a subgroup analysis of patients with new-onset disease showed Palb was no longer significantly associated with Birmingham Vasculitis Activity Score (BVAS). Multivariate linear regression showed Alb level (standardized β = -0.377; 95% confidence interval: -5.623, -1.260; p = 0.003) was an independent predictor of BVAS at baseline. Conclusions Among Alb, Palb, and IMA, we found that Alb could be a useful marker indicating disease activity in patients with AAV.

the serum ischemia modified albumin in patients with ankylosing spondylitis

“…It is consistent with these findings, it had been observed that serum level of IMA is increased in patients with diseases involving ischemia and hypoxia, and in patients with chronic inflammatory diseases including the inflammatory rheumatic diseases such as RA [32], IBD [33], Behçet disease [34], and vasculitis [35] On the other hand, a previous study evaluated the IMA levels, and their relationship with ATS in Sjögren syndrome, and found no relationship between the IMA levels and inflammatory parameters or subclinical ATS in this disease [36].…”

Serum Albumin Levels: A Biomarker to Be Repurposed in Different Disease Settings in Clinical Practice

“…Recently, Ahn SS et al (2022) prospectively evaluated the relationship between disease activity and serum ALB, prealbumin, and ischemia-modified albumin in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), revealing that only serum ALB concentrations increased consensually when disease activity improved [ 96 ].…”

Factors associated with cytomegalovirus infection in antineutrophil cytoplasmic antibody‐associated vasculitis: A narrative review

“…Albumin levels show a strong correlation with the Birmingham Vasculitis Activity Score and have been found to increase following treatment. 67 It was interesting to note that shorter duration of the underlying rheumatic disease showed a significant association with CMV infection in the current review 47 as it would follow that a longer disease duration would have a cumulatively greater exposure to glucocorticoids and immunosuppressive treatment, and by extension, immunocompromised state and susceptibility to opportunistic infection. In the study in question by Xue et al, 47 the shorter duration might have occurred because seven of the 73 patients with CMV infection died, with 42.9% of them having concomitant fungal infection.…”

“…Hypoalbuminemia and its association with the development of CMV infection may be reflective of high disease activity of the patient's underlying AAV, causing the individual to be susceptible to opportunistic infection as serum albumin is a negative inflammatory biomarker showing an inverse correlation with disease activity in AAV patients. Albumin levels show a strong correlation with the Birmingham Vasculitis Activity Score and have been found to increase following treatment 67 …”