Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb 11:45:101301.
doi: 10.1016/j.eclinm.2022.101301. eCollection 2022 Mar.

Admission serum albumin concentrations and response to nutritional therapy in hospitalised patients at malnutrition risk: Secondary analysis of a randomised clinical trial

Céline Bretschera  1 , Fabienne Boesiger  1 , Nina Kaegi-Braun  1 , Lara Hersberger  1 , Dileep N Lobo  2 , David C Evans  3 , Pascal Tribolet  1   4 , Filomena Gomes  1   5 , Claus Hoess  6 , Vojtech Pavlicek  6 , Stefan Bilz  7 , Sarah Sigrist  7 , Michael Brändle  7 , Christoph Henzen  8 , Robert Thomann  9 , Jonas Rutishauser  10 , Drahomir Aujesky  11 , Nicolas Rodondi  11   12 , Jacques Donzé  13   14 , Zeno Stanga  15 , Beat Mueller  1   16 , Philipp Schuetz  1   16
Affiliations

Admission serum albumin concentrations and response to nutritional therapy in hospitalised patients at malnutrition risk: Secondary analysis of a randomised clinical trial

Céline Bretschera et al. EClinicalMedicine. .

Abstract

Background: Historically, admission serum albumin concentrations have been considered useful biochemical markers for nutrition assessment. However, there is a lack of randomised trial data investigating whether low albumin concentrations are helpful for identifying patients benefitting from nutritional support.

Methods: This study was a secondary analysis of the EFFORT trial, a Swiss-wide multicentre, randomised controlled trial comparing individualised nutritional support with usual care nutrition in medical inpatients from April 1, 2014, to February 1, 2018. 1389 of 2028 patients at nutritional risk with available albumin concentrations on admission were included. The primary endpoint was all-cause mortality within 30 and 180 days. Patients were stratified into groups of low or normal albumin based on the albumin cut-off of 30 g/L. ClinicalTrials.gov number, NCT02517476.

Findings: 1389 patients (mean age, 73.1 (SD 3.5) years; 747 (53.8%) men) were included and 676 (48.7%) had low serum albumin concentrations at admission (<30 g/L). Mortality at 180 days was significantly increased in the low albumin group compared with patients with normal albumin concentrations (219/676 (32.4%) vs. 162/713 (22.7%), fully adjusted HR 1.4, 95%CI 1.11 to 1.77, p = 0.005]. Effects of nutritional support on 30-day mortality were similar for patients with low compared to patients with normal albumin concentrations (HR 0.68, 95%CI 0.44 to 1.05 vs. HR 0.70, 95%CI 0.41 to 1.20), with no evidence for a subgroup effect (p for interaction=0.97).

Interpretation: Based on this secondary analysis of a randomised trial, low admission serum albumin concentrations in hospitalised, non-critically ill, medical patients at nutritional risk had prognostic implications and indicated higher mortality risk but were not helpful in selecting patients for nutritional interventions.

Funding: The Swiss National Science Foundation (SNSF) (PP00P3_150531) and the Research Council of the Kantonsspital Aarau (1410.000.058 and 1410.000.044) provided funding for the EFFORT trial.

Keywords: C-reactive protein; Inflammation; Malnutrition; Nutritional support; Outcomes; Serum albumin.

PubMed Disclaimer

Conflict of interest statement

Dr. Schuetz reports grants from Neste Health Science, grants from Abbott Nutrition (outside the submitted work). Dr. Stanga reports grants and personal fees from Neste Health Science, grants from Abbott Nutrition, personal fees from Fresenius Kabi (outside the submitted work). All other authors report no conflicts of interest.

Figures

Figure1
Figure 1
Study profile. Abbreviations: CRP: C-reactive protein.
Figure 2
Figure 2
Kaplan-Meier estimates for time to death within 180 days for prognostic value stratified by admission albumin concentrations for the overall population (A); for patients with moderate nutritional risk (B) and high nutritional risk (C); and for patients with low and moderate inflammation (D) and high inflammation (E).
Figure 2
Figure 2
Kaplan-Meier estimates for time to death within 180 days for prognostic value stratified by admission albumin concentrations for the overall population (A); for patients with moderate nutritional risk (B) and high nutritional risk (C); and for patients with low and moderate inflammation (D) and high inflammation (E).
Figure 3
Figure 3
Kaplan-Meier estimate for time to death within 30 days stratified by randomization into the intervention group and control group; and stratified by admission albumin concentrations.
Figure 4
Figure 4
Effect of nutritional support on 30-day mortality overall, stratified by serum albumin concentration, inflammation level (CRP) and nutritional risk (NRS). Abbreviations: HR: hazard ratio, CI: confidence interval, CRP: C-reactive protein, NRS: nutritional risk screening.
Figure 4
Figure 4
Effect of nutritional support on 30-day mortality overall, stratified by serum albumin concentration, inflammation level (CRP) and nutritional risk (NRS). Abbreviations: HR: hazard ratio, CI: confidence interval, CRP: C-reactive protein, NRS: nutritional risk screening.
See this image and copyright information in PMC

References

    1. Blackburn G.L., Bistrian B.R., Maini B.S., Schlamm H.T., Smith M.F. Nutritional and metabolic assessment of the hospitalized patient. JPEN J Parenter Enter Nutr. 1977;1(1):11–21. - PubMed
    1. Evans D.C., Corkins M.R., Malone A., et al. The use of visceral proteins as nutrition markers: an ASPEN position paper. Nutr Clin Pract. 2021;36(1):22–28. - PubMed
    1. Eckart A., Struja T., Kutz A., et al. Relationship of nutritional status, inflammation, and serum albumin levels during acute illness: a prospective study. Am J Med. 2020;133(6):713–722. e7. - PubMed
    1. Schuetz P., Seres D., Lobo D.N., Gomes F., Kaegi-Braun N., Stanga Z. Management of disease-related malnutrition for patients being treated in hospital. Lancet. 2021;398(10314):1927–1938. - PubMed
    1. Felder S., Braun N., Stanga Z., et al. Unraveling the link between malnutrition and adverse clinical outcomes: association of acute and chronic malnutrition measures with blood biomarkers from different pathophysiological states. Ann Nutr Metab. 2016;68(3):164–172. - PubMed

Associated data