The prognostic value of serial measurements of serum albumin concentration in patients admitted to an intensive care unit

McCluskey, A.; Thomas, Antony; Bowles, B. Jason; Kishen, Roop

doi:10.1111/j.1365-2044.1996.tb07883.x

Cited by 88 publications

(37 citation statements)

References 15 publications

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“…This study also shows that leukocytosis is associated with thrombocytosis, a known negative prognostic indicator in patients with cancer [21,22]. In this cohort baseline leukocytosis correlates with several clinical findings known to be associated with underlying inflammation including thrombocytosis [23], hyperglycemia [24,25], hypoalbuminemia [26,27], and transaminitis [28,29]. …”

Section: Discussionmentioning

confidence: 55%

Leukocytosis, thrombosis and early mortality in cancer patients initiating chemotherapy

Connolly¹,

Khorana²,

Kuderer³

et al. 2010

Thrombosis Research

121

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Background Leukocytosis has been associated with thrombosis and mortality in cancer patients. We explored the association of leukocytosis with venous thromboembolism (VTE) and early mortality in cancer patients initiating chemotherapy. Methods Data from a prospective, multicenter observational study of treatment-related complications in 4,405 ambulatory cancer patients initiating chemotherapy was used for this analysis. The association of leukocytosis, VTE and mortality during the course of chemotherapy was evaluated in univariate and multivariate analysis. Results Ninety-three patients (2.1%) developed VTE and 134 (3%) died over a median follow up of 75 days (range 0–384). Of 4391 patients with available baseline white blood cell (WBC) count, 561 (12.8%) had elevated pretreatment leukocyte counts, defined as WBC > 11×109 cells/L. VTE occurred in 25 of 561 patients (4.5%) with baseline leukocytosis compared to 68 of 3830 (1.8%) with WBC ≤ 11×109 cells/L (P<0.0001). Baseline leukocytosis was associated with VTE by multivariate analysis as well (HR 2.1, 95% confidence interval 1.3–3.4, p=0.003). Forty one patients (7.3%) with leukocytosis died compared to 92 (2.4%) with WBC ≤ 11×109 cells/L (P<0.0001). Baseline leukocytosis was associated with early mortality by multivariate analysis as well (HR 2.2, 95% confidence interval 1.5–3.3, p<0.0001). Mortality was greatest in patients with both leukocytosis and VTE. In multivariate analysis several factors were predictive of leukocytosis. Conclusions Elevated WBC, particularly neutrophils, is strongly associated with increased risk of VTE and mortality in cancer patients receiving systemic chemotherapy. Further studies are needed to elicit the mechanisms involved.

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Section: Discussionmentioning

confidence: 55%

Leukocytosis, thrombosis and early mortality in cancer patients initiating chemotherapy

Connolly¹,

Khorana²,

Kuderer³

et al. 2010

Thrombosis Research

121

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“…Reduced serum albumin concentration correlates with the increased mortality of critically ill patients 25,26. Previously, it has been shown that the BChE activity correlates with the albumin concentration in critically ill patients with severe systemic inflammation 7.…”

Section: Discussionmentioning

confidence: 98%

Reduced butyrylcholinesterase activity is an early indicator of trauma-induced acute systemic inflammatory response

Zivkovic¹,

Bender²,

Brenner³

et al. 2016

JIR

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PurposeEarly diagnosis of systemic inflammatory response syndrome is fundamentally important for an effective and a goal-directed therapy. Various inflammation biomarkers have been used in clinical and experimental practice. However, a definitive diagnostic tool for an early detection of systemic inflammation remains to be identified. Acetylcholine (Ach) has been shown to play an important role in the inflammatory response. Serum cholinesterase (butyrylcholinesterase [BChE]) is the major Ach hydrolyzing enzyme in blood. The role of this enzyme during inflammation has not yet been fully understood. This study tests whether a reduction in the BChE activity could indicate the onset of the systemic inflammatory response upon traumatic injury.Patients and methodsThis observational study measured BChE activity in patients with traumatic injury admitted to the emergency room by using point-of-care-test system (POCT). In addition, the levels of routine inflammation biomarkers during the initial treatment period were measured. Injury Severity Score was used to assess the trauma severity.ResultsAltered BChE activity was correlated with trauma severity, resulting in systemic inflammation. Reduction in the BChE activity was detected significantly earlier compared to those of routinely measured inflammatory biomarkers.ConclusionThis study suggests that the BChE activity reduction might serve as an early indicator of acute systemic inflammation. Furthermore, BChE activity, measured using a POCT system, might play an important role in the early diagnosis of the trauma-induced systemic inflammation.

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“…One study that comprised Swedish elderly patients with community-acquired pneumonia [33] and two studies including intensive care unit patients [34,35] supported our view that hypoalbuminaemia mainly reflected an acute inflammatory response. Our results are in line with results reported in those studies.…”

Section: Discussionmentioning

confidence: 91%

Association between Hypoalbuminaemia and Mortality in Patients with Community-Acquired Bacteraemia Is Primarily Related to Acute Disorders

et al. 2016

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We sought to investigate whether hypoalbuminaemia was mainly caused by acute or chronic factors in patients with community-acquired bacteraemia. In this population-based study, we considered 1844 adult cases of community-acquired bacteraemia that occurred in Funen, Denmark between 2000 and 2008. We used a stepwise prognostic predisposition-insult-response-organ dysfunction (PIRO) logistic regression model by initially including age and comorbidity, then added bacterial species, and finally sepsis severity. The models were furthermore analysed using receiver operating characteristic (ROC) curves. Outcomes comprised mortality incidence on days 0–30 and 31–365 after the bacteraemia episode. Each step was performed with and without baseline albumin level measured on the date of bacteraemia. In 422 patients, their latest albumin measurement taken 8–30 days before the date of bacteraemia was also used in the analysis together with the baseline albumin level. For each decrease of 1g/L in plasma albumin level, the odds ratios (95% confidence intervals) of mortality in the period of 0–30 days after bacteraemia were 0.86 (0.84–0.88) in both predisposition (P) and predisposition-insult (PI) models and 0.87 (0.85–0.89) in the full PIRO-model. The AUC values were 0.78 and 0.66 for mortality in the period of 0–30 days in the model comprising only predisposition factors with and without albumin levels added as a factor, respectively. The AUC values in the full PIRO-model were 0.81 and 0.73 with and without consideration of albumin levels, respectively. A higher proportion of patients died within 30 days if there was a decrease in the albumin level between days 8 and 30 before bacteraemia and the actual bacteraemia date. A single plasma albumin measurement on the bacteraemia date was a better prognostic predictor of short-term mortality than the sepsis severity score.

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The prognostic value of serial measurements of serum albumin concentration in patients admitted to an intensive care unit

Cited by 88 publications

References 15 publications

Leukocytosis, thrombosis and early mortality in cancer patients initiating chemotherapy

Leukocytosis, thrombosis and early mortality in cancer patients initiating chemotherapy

Reduced butyrylcholinesterase activity is an early indicator of trauma-induced acute systemic inflammatory response

Association between Hypoalbuminaemia and Mortality in Patients with Community-Acquired Bacteraemia Is Primarily Related to Acute Disorders

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