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Review
. 2025 Feb 25:5:104223.
doi: 10.1016/j.bas.2025.104223. eCollection 2025.

The utilization of hypoalbuminemia as a prognostic metric in patients with spinal metastases: A scoping review

Jessica Ryvlin  1 , Namal Seneviratne  2 , Ali Haider Bangash  1   3 , C Rory Goodwin  4 , Michael H Weber  5 , Raphaële Charest-Morin  6 , John H Shin  7 , Anne L Versteeg  8 , Mitchell S Fourman  9 , Saikiran G Murthy  1   3 , Yaroslav Gelfand  1   3 , Reza Yassari  1   3 , Rafael De la Garza Ramos  1   3
Affiliations
Review

The utilization of hypoalbuminemia as a prognostic metric in patients with spinal metastases: A scoping review

Jessica Ryvlin et al. Brain Spine. .

Abstract

Introduction: Hypoalbuminemia is associated with poor outcomes in cancer patients, but its role in spinal metastases remains unclear.

Research question: This study aimed to identify albumin cutoff values defining hypoalbuminemia and describe the association between serum albumin and outcomes in patients with spinal metastases.

Material and methods: A narrative review of articles up to December 2022 was conducted using PubMed/Medline, EMBASE, and Web of Science databases. Variables extracted included study design, patient characteristics, serum albumin levels, treatments, and levels of evidence. Outcomes included survival/mortality, complications, ambulatory status, readmission, length of stay, discharge disposition, and blood loss.

Results: Thirty-eight studies comprising 21,401 patients were analyzed. Most studies (92%) were Level of Evidence III. Albumin was evaluated as a continuous variable in 18% of studies and as a dichotomous variable in 76%, with 3.5 g/dL being the most common threshold for hypoalbuminemia. Primary outcomes evaluated were survival/mortality (71% of studies), complications (34%), and reoperation/readmission (11%). Of studies examining the association between hypoalbuminemia and survival/mortality, 74% found a significant association. An association between albumin levels and complications was found in 54% of relevant studies.

Discussion and conclusion: The findings of this study suggest that a threshold of 3.5 g/dL seems most appropriate to define hypoalbuminemia in patients with spinal metastases. However, evidence also supports a level-dependent effect. The most consistent significant association was between low albumin and survival at both fixed and continuous time points. There is less evidence to support an association between hypoalbuminemia and other endpoints such as perioperative complications.

Keywords: Albumin; Complications; Metastatic spine disease; Spine metastasis; Spine oncology; Survival.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Study selection algorithm.
Fig. 2
Fig. 2
Distribution of studies utilizing different albumin measures categorized by association with any outcome.
Fig. 3
Fig. 3
Distribution of studies utilizing different albumin measures categorized by association with survival/mortality.
Fig. 4
Fig. 4
Distribution of studies utilizing different albumin measures categorized by association with complications.
See this image and copyright information in PMC

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