Hypoalbuminaemia as a marker of trans-capillary leakage in community-acquired bacteraemia patients

Abstract

Community-acquired bacteraemia patients (n = 2472), Denmark, 2000-2008. Albumin, C-reactive protein (CRP) and haemoglobin (Hb) measured 2000-2010. We assessed daily mean levels of albumin, CRP and Hb from 30 days before to 30 days after bacteraemia and correlations between albumin vs. CRP and albumin vs. Hb. In linear regression models, we evaluated the contribution of CRP, Hb, chronic and acute variables to the albumin level variations. The mean albumin level (33.6 g/l) was steady before day 1, declined to 29.3 g/l on day 1 with little increase afterward. The mean CRP increased from day -5, peaked on day 1 and declined thereafter. The mean Hb level was fairly constant during days -30/30. Albumin was inversely (R range, - 0.18/-0.47, P < 10-4) correlated with the CRP level and positively (R = 0.17-0.46, P < 10-4) correlated with the HB level. In most models, CRP was the first variable that contributed to the albumin variations, 34-70% of the full model. The sudden decrease of albumin levels, without sudden fluctuations of CRP or Hb, indicated that hypoalbuminaemia was a marker of trans-capillary leakage.

Keywords: Bloodstream infections; Septicaemia.

Fig. 1.

Number of specimen dates (with plasma albumin, C-reactive protein and/or haemoglobin measured) per person-year (represented by the area of a circle in upper panel and numbers in lower panel).

Fig. 2.

Mean levels and their 95% confidence intervals of plasma albumin (upper panel), C-reactive protein (middle panel) and haemoglobin (lower panel) from 30 days before through 30 days after the date of bacteraemia (day 0, marked by vertical red line).

Fig. 3.

Box plots of plasma albumin levels for equal-range groups of the natural logarithm of C-reactive protein (left panel) and haemoglobin levels (right panel) from 30 days before through 30 days after the date of bacteraemia.