Andreas Eckart1, Tristan Struja2, Alexander Kutz3, Annic Baumgartner2, Thomas Baumgartner3, Seline Zurfluh3, Olivia Neeser3, Andreas Huber4, Zeno Stanga5, Beat Mueller6, Philipp Schuetz7. 1. Division of General Internal and Emergency Medicine; University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland. Electronic address: eckartan@gmail.com. 2. Division of General Internal and Emergency Medicine; University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland; Division of Endocrinology, Diabetes and Metabolism; University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland. 3. Division of General Internal and Emergency Medicine; University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland. 4. Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland. 5. Department of Diabetes, Endocrinology, Clinical Nutrition and Metabolism, Bern University Hospital, Inselspital Bern, Bern, Switzerland. 6. Division of Endocrinology, Diabetes and Metabolism; University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty, University of Basel, Basel, Switzerland. 7. Division of General Internal and Emergency Medicine; University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty, University of Basel, Basel, Switzerland.
Abstract
BACKGROUND: Low serum albumin levels resulting from inflammation-induced capillary leakage or disease-related anorexia during acute illness are associated with poor outcomes. We investigated the relationship of nutritional status and inflammation with low serum albumin levels and 30-day mortality in a large cohort. METHODS: We prospectively enrolled adult patients in the medical emergency department of a Swiss tertiary care center and investigated associations of C-reactive protein (CRP) and Nutritional Risk Screening 2002 as markers of inflammation and poor nutritional status, respectively, with low serum albumin levels and mortality using multivariate regression analyses. RESULTS: Among the 2465 patients, 1019 (41%) had low serum albumin levels (<34 g/L), 619 (25.1%) had increased nutritional risk (Nutritional Risk Screening 2002 ≥3), and 1086 (44.1%) had CRP values >20 mg/L. Multivariate analyses adjusted for age, gender, diagnosis, and comorbidities revealed elevated CRP values (adjusted odds ratio [OR] 10.51, 95% confidence interval, 7.51-14.72, P <.001) and increased malnutrition risk (adjusted OR 2.87, 95% confidence interval, 1.98-4.15, P <.001) to be associated with low serum albumin levels, even adjusting for both parameters. Low serum albumin levels, elevated CRP values, and increased nutritional risk independently predicted 30-day mortality, with areas under the curve of 0.77, 0.70, and 0.75, respectively. Combination of these 3 parameters showed an area under the curve of 0.82 to predict mortality. CONCLUSIONS: Elevated parameters of inflammation and high nutritional risk were independently associated with hypoalbuminemia. All 3 parameters independently predicted mortality. Combining them during initial evaluation of patients in emergency departments facilitates mortality risk stratification.
BACKGROUND: Low serum albumin levels resulting from inflammation-induced capillary leakage or disease-related anorexia during acute illness are associated with poor outcomes. We investigated the relationship of nutritional status and inflammation with low serum albumin levels and 30-day mortality in a large cohort. METHODS: We prospectively enrolled adult patients in the medical emergency department of a Swiss tertiary care center and investigated associations of C-reactive protein (CRP) and Nutritional Risk Screening 2002 as markers of inflammation and poor nutritional status, respectively, with low serum albumin levels and mortality using multivariate regression analyses. RESULTS: Among the 2465 patients, 1019 (41%) had low serum albumin levels (<34 g/L), 619 (25.1%) had increased nutritional risk (Nutritional Risk Screening 2002 ≥3), and 1086 (44.1%) had CRP values >20 mg/L. Multivariate analyses adjusted for age, gender, diagnosis, and comorbidities revealed elevated CRP values (adjusted odds ratio [OR] 10.51, 95% confidence interval, 7.51-14.72, P <.001) and increased malnutrition risk (adjusted OR 2.87, 95% confidence interval, 1.98-4.15, P <.001) to be associated with low serum albumin levels, even adjusting for both parameters. Low serum albumin levels, elevated CRP values, and increased nutritional risk independently predicted 30-day mortality, with areas under the curve of 0.77, 0.70, and 0.75, respectively. Combination of these 3 parameters showed an area under the curve of 0.82 to predict mortality. CONCLUSIONS: Elevated parameters of inflammation and high nutritional risk were independently associated with hypoalbuminemia. All 3 parameters independently predicted mortality. Combining them during initial evaluation of patients in emergency departments facilitates mortality risk stratification.