The meaning of hypoalbuminaemia in clinical practice

Franch-Arcas, Guzmán

doi:10.1054/clnu.2001.0438

Cited by 198 publications

(145 citation statements)

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“…Value below this level showed to be an independent predictor of death (OR: 4.9, 95% CI: 2.7-9.1, p = 0.0001,). Hypoalbuminemia is associated with multiple debilitating clinical conditions such as malnutrition, diabetes mellitus, renal failure, and chronic liver disease (32)(33)(34)(35)(36). Since albumin has multiple biological functions, it is widely accepted that hypoalbuminemia is a risk factor of mortality in some diseases (35).…”

Section: Discussionmentioning

confidence: 99%

Predictors of in-hospital mortality in patients with non-variceal upper gastrointestinal bleeding

González-González

Vázquez-Elizondo

García-Compeán

et al. 2011

Rev. esp. enferm. dig.

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Objective: to determine the independent predictors of in-hospital death of Hispanic patients with nonvariceal upper gastrointestinal bleeding (NVUGB).Experimental design: prospective and observational trial. Patients: in a period between 2000 and 2009, all patients with NVUGB admitted to our hospital were studied. Demographical and clinical characteristics, endoscopic findings and laboratory tests were evaluated. χ² and Mann-Whitney U analyses were performed for comparisons, and binary logistic regression was employed to identify independent predictors of in-hospital mortality.Results: 1,067 patients were included, 65% male with a mean age of 58.8 years. Mean number of comorbidities per patient was 1.6 ± 0.76. The most frequent cause of bleeding were gastric and duodenal ulcers (55.4%); 278 patients (25.8%) received endoscopic treatment of which 69.1% had combined therapy. Rebleeding occurred in 36 patients (3.4%) of which 50% died. Inhospital mortality was 10.2%, of which only 3.1% was associated to bleeding. When comparing causes of death among patients with and without comorbidities, only hypovolemic shock was found significative (48.3 vs. 25%; p = 0.020). Binary logistic regression found that the number of comorbidities, Rockall scale serum albumin < 2.6 g/dL on admission; rebleeding and length of hospital stay were independent risk factors of in-hospital mortality.Conclusion: the number of comorbidities, the Rockall scale score, an albumin level < 2.6 g/dL, the presence of rebleeding and hospital stay were predictors of in-hospital mortality in patients with UNVGB. INTRODUCTIONNon-variceal upper gastrointestinal bleeding (NVUGB) is a critical condition in which a mortality of 5 to 10% has been reported in different series of patients. This variability may be explained in part by the different clinical and demographic characteristics of the studied population (1,2). Recent prospective studies have identified different predictors of mortality; it is worth noting that the use of proton pump inhibitors (PPIs) significantly reduces mortality in patients both with and without high risk stigmata of rebleeding. Moreover, the use of endoscopic treatment has been demonstrated to reduce mortality in greater proportion than drug treatment (3-6). However, it has been shown that the risk factors, complications and mortality rates described in controlled trials are lower than those reported in patients who received their attention on "day-today conditions" in a tertiary care community hospital (7), which illustrates more accurately the actual conditions of medical care.The main objective of our study is to describe the clinical characteristics, endoscopic findings, and treatment used, as well as risk factors of complications and in-hospital mortality in Hispanic patients with NVUGB on "day-to-day conditions". Predictors of in-hospital mortality in patients with non-variceal upper gastrointestinal bleedingJosé Alberto González-González, Genaro Vázquez-Elizondo, Diego García-Compeán, Juan Obed Gaytán-Torres, Ángel Ricardo ...

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Section: Discussionmentioning

confidence: 99%

Predictors of in-hospital mortality in patients with non-variceal upper gastrointestinal bleeding

González-González

Vázquez-Elizondo

García-Compeán

et al. 2011

Rev. esp. enferm. dig.

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“…Hypoalbuminaemia correlates with poor outcome in patients with advanced malignancy, 28 an association that was previously presumed to be due to nutritional depletion secondary to the tumour. Recently, however, it has been postulated that hypoalbuminaemia develops secondary to the SIR.…”

Section: Introductionmentioning

confidence: 96%

Evaluation of the prognostic value of systemic inflammation and socioeconomic deprivation in patients with resectable colorectal liver metastases

Neal¹,

Mann²,

Sutton³

et al. 2009

European Journal of Cancer

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Background: There is increasing evidence that the presence of a preoperative systemic inflammatory response (SIR) independently predicts poor long-term outcome in patients with colorectal cancer (CRC).Socioeconomic deprivation was reported to correlate with the presence of the SIR and to itself independently predict poor outcome following primary CRC resection. The aim of this study was to determine the prognostic value of preoperative systemic inflammatory biomarkers and socioeconomic deprivation in patients undergoing resection of colorectal liver metastases (CLM) and to examine correlations between these variables in this context. Results: On multivariable analysis, poor CRS (3-5), high neutrophil count (>6.0 x10 9 /L) and low serum albumin (<40 g/dL) were the only independent predictors of shortened overall survival following metastasectomy, with neutrophil count representing the greatest relative risk of death. These factors were also the only independent predictors of shortened disease-free survival 3 following hepatectomy. Socioeconomic deprivation was associated with neither systemic inflammation nor long-term outcome in this context. Patients and methods: Conclusions:The presence of a preoperative systemic inflammatory response, but not socioeconomic deprivation, independently predicts shortened survival following resection of CLM.4

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“…These results show that hypoalbuminaemia is associated with the presence of a systemic inflammatory response rather than tumour volume in patients with colorectal liver metastases. It has long been recognised that, in patients with advanced cancer, the presence of hypoalbuminaemia is associated with poor outcome (Franch-Arcas, 2001). In the past, this hypoalbuminaemia has been thought to be the result of nutritional depletion secondary to the tumour.…”

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confidence: 99%

“…It has long been recognised that, in patients with advanced cancer, the presence of hypoalbuminaemia is associated with poor outcome (Franch-Arcas, 2001). In the past, this hypoalbuminaemia has been thought to be the result of nutritional depletion secondary to the tumour.…”

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confidence: 99%

The relationship between hypoalbuminaemia, tumour volume and the systemic inflammatory response in patients with colorectal liver metastases

et al. 2004

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The relationship between hypoalbuminaemia, tumour volume and C-reactive protein was examined in patients with colorectal liver metastases (n ¼ 57). On multiple regression analysis, albumin concentrations were independently associated with C-reactive protein (r ¼ 0.56, Po0.001) but not percentage hepatic replacement (P ¼ 0.34). These results show that hypoalbuminaemia is associated with the presence of a systemic inflammatory response rather than tumour volume in patients with colorectal liver metastases. It has long been recognised that, in patients with advanced cancer, the presence of hypoalbuminaemia is associated with poor outcome (Franch-Arcas, 2001). In the past, this hypoalbuminaemia has been thought to be the result of nutritional depletion secondary to the tumour. Recently, however, it has been postulated that the reduction in albumin concentration is secondary to the presence of a systemic inflammatory response, as evidenced by elevated circulating concentrations of C-reactive protein (McMillan et al, 2001).The nature of the relationship between circulating albumin concentration, tumour burden and the systemic inflammatory response has not been established. However, if the presence of a systemic inflammatory response rather than tumour burden were to determine the development of the hypoalbuminaemia associated with advanced cancer, then it might be expected that there would be a stronger relationship between the presence of hypoalbuminaemia and the systemic inflammatory response compared with that between hypoalbuminaemia and tumour volume.The aim of the present study was to examine the relationship between circulating albumin concentration, the tumour burden and the systemic inflammatory response in patients with colorectal liver metastases. MATERIAL AND METHODS PatientsPatients who had undergone resection of a primary colorectal cancer, who then developed liver metastases and who were referred for assessment for liver resection, were considered eligible for study. As part of their assessment, patients underwent dual phase spiral-computed tomography of the liver. In addition a blood sample was taken for measurement of routine liver enzymes, albumin and C-reactive protein. Only those patients who had no evidence of extrahepatic disease were included in the study. None of the patients had recent chemotherapy.The study was approved by the Research Ethics Committee of Glasgow Royal Infirmary. Biochemical profileAlbumin, C-reactive protein, alkaline phosphatase, aspartate transaminase, alanine transaminase and bilirubin concentrations were assayed using standard methods. Intra-and inter-assay coefficients of variation were better than 5 and 10% respectively. Tumour volume and PHRTumour volume and percentage hepatic replacement (PHR) were measured using a similar approach to that previously described (Purkiss and Williams, 1992;Dworkin et al, 1995). Contrast enhanced CT-scans were performed using a Somatom plus 4 spiral-CT scanner (Siemens AG, Erlangen, Germany).The cross-sectional areas of all the metastat...

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The meaning of hypoalbuminaemia in clinical practice

Cited by 198 publications

References 34 publications

Predictors of in-hospital mortality in patients with non-variceal upper gastrointestinal bleeding

Predictors of in-hospital mortality in patients with non-variceal upper gastrointestinal bleeding

Evaluation of the prognostic value of systemic inflammation and socioeconomic deprivation in patients with resectable colorectal liver metastases

The relationship between hypoalbuminaemia, tumour volume and the systemic inflammatory response in patients with colorectal liver metastases

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