Low serum albumin level deteriorates prognosis in azacitidine-treated myelodysplastic syndromes patients – results of the PALG study ‘PolAZA’

AbstractHypoalbuminemia is associated with morbidity and mortality in critically ill children. In this multi-centre retrospective study, we aimed to determine normative values of serum albumin in neonates and infants with congenital heart disease, evaluate perioperative changes in albumin levels, and determine if low serum albumin influences post-operative outcomes. Consecutive eligible neonates and infants who underwent cardiac surgery with cardiopulmonary bypass at one of three medical centres, January 2012–August 2013, were included. Data on serum albumin levels from five data points (pre-operative, 0–24, 24–48, 48–72, 72 hours post-operative) were collected. Median pre-operative serum albumin level was 2.5 g/dl (IQR, 2.1–2.8) in neonates versus 4 g/dl (IQR, 3.5–4.4) in infants. Hypoalbuminemia was defined as <25th percentile of these values. A total of 203 patients (126 neonates, 77 infants) were included in the study. Post-operative hypoalbuminemia developed in 12% of neonates and 20% of infants; 97% occurred in the first 48 hours. In multivariable analysis, perioperative hypoalbuminemia was not independently associated with any post-operative morbidity. However, when analysed as a continuous variable, lower serum albumin levels were associated with increased post-operative morbidity. Pre-operative low serum albumin level was independently associated with increased odds of post-operative hypoalbuminemia (OR, 3.67; 95% CI, 1.01–13.29) and prolonged length of hospital stay (RR, 1.40; 95% CI, 1.08–1.82). Lower 0–24-hour post-operative serum albumin level was independently associated with an increased duration of mechanical ventilation (RR, 1.35; 95% CI, 1.12–1.64). Future studies should further assess hypoalbuminemia in this population, with emphasis on evaluating clinically meaningful cut-offs and possibly the use of serum albumin levels in perioperative risk stratification models.

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Prognostic factors in aggressive malignant lymphomas: description and validation of a prognostic index that could identify patients requiring a more intensive therapy. The Groupe d'Etudes des Lymphomes Agressifs.

Journal of Clinical Oncology ◽

10.1200/jco.1991.9.2.211 ◽

1991 ◽

Vol 9 (2) ◽

pp. 211-219 ◽

Cited By ~ 156

Author(s):

B Coiffier ◽

C Gisselbrecht ◽

J M Vose ◽

H Tilly ◽

R Herbrecht ◽

...

Keyword(s):

Bone Marrow ◽

Overall Survival ◽

Prognostic Factors ◽

Serum Albumin ◽

Serum Albumin Level ◽

Bone Marrow Involvement ◽

Prognostic Index ◽

Albumin Level ◽

Advanced Stage ◽

Low Serum

The objectives of this study were to determine prognostic factors for response to treatment, freedom-from-relapse (FFR) survival, and overall survival of 737 aggressive malignant lymphoma patients treated with the doxorubicin, cyclophosphamide, vindesine, bleomycin, methylprednisolone, methotrexate with leucovorin, ifosfamide, etoposide, asparaginase, and cytarabine (LNH-84) regimen; to construct a prognostic index with factors isolated by multivariate analyses; and to validate this prognostic index with another set of patients. Complete response (CR) was reached in 75% of LNH-84 patients, and 30% of them relapsed. With a median follow-up of 36 months, median FFR survival and median overall survival were not reached. Low serum albumin level, high tumoral mass, weight loss, bone marrow involvement, greater than or equal to 2 extranodal sites, and increased lactic dehydrogenase (LDH) level were associated with a low response rate. Advanced stage, increased LDH level, and nonlarge-cell histologic subtypes (diffuse mixed, lymphoblastic, and small non-cleaved) were statistically associated with a high relapse rate and short FFR survival. Increased LDH level, low serum albumin level, tumoral mass larger than 10 cm, greater than or equal to 2 extranodal sites, advanced stage, and age older than 65 years were statistically associated with short overall survival. Four of these parameters, namely, LDH level, stage, number of extranodal sites, and tumoral mass, were put together to construct a prognostic index. This index partitioned LNH-84 patients into three subgroups of good, intermediate, and poor prognosis (P less than .00001): CR rates of 93%, 83%, and 61%; relapse rates of 12%, 25%, and 45%; 3-year FFR survival of 87%, 73%, and 53%, and 3-year survival of 88%, 71%, and 41%, respectively. This prognostic index was applied to a test set of patients: 155 patients treated on protocols of the Nebraska Lymphoma Study Group. Using this index, these patients had 3-year FFR survival of 70%, 40%, and 22% (P = .0002) and 3-year survival of 79%, 52%, and 31% (P = .005). In patients with aggressive lymphomas, this simple prognostic index could distinguish between patients requiring intensive treatment such as autologous bone marrow transplantation in first complete remission and those who could be treated with standard regimens.

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Is low serum albumin level a risk factor for deep venous thrombosis in temporary hemodialysis catheter inserted patients?

Turkish Journal of Thoracic and Cardiovascular Surgery ◽

10.5606/tgkdc.dergisi.2013.7721 ◽

2013 ◽

Vol 21 (4) ◽

pp. 955-958

Author(s):

Ufuk Aydın

Keyword(s):

Risk Factor ◽

Serum Albumin ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Serum Albumin Level ◽

Albumin Level ◽

Hemodialysis Catheter ◽

Low Serum

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Hypoalbuminemia Is An Independent Prognostic Factor In Myelodysplastic Syndromes

Blood ◽

10.1182/blood.v116.21.4001.4001 ◽

2010 ◽

Vol 116 (21) ◽

pp. 4001-4001

Author(s):

Maria Corrales-Yepez ◽

Mohamed A. Kharfan-Dabaja ◽

Jeffrey Lancet ◽

Alan F. List ◽

Eric Padron ◽

...

Keyword(s):

Prognostic Factor ◽

Serum Albumin ◽

Serum Albumin Level ◽

Risk Group ◽

Risk Groups ◽

Albumin Level ◽

Refractory Anemia ◽

Lower Serum ◽

Kaplan Meier ◽

Low Serum

Abstract Abstract 4001 Background: Low serum albumin level is known to be an adverse prognostic factor in patients with malignancies such as multiple myeloma. We previously reported that severe hypoalbuminemia (<3.0 g/dl) at day +90 post allogeneic hematopoietic stem cell transplant (AHCT) was an independent predictor of non-relapse and overall mortality in patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) (Kharfan-Dabaja et al Biol Blood Marrow Transplant. 2010 Jul). In this study we examined prognostic value of serum albumin level in patients with MDS. Methods: Data were analyzed from the Moffitt Cancer Center (MCC) MDS database with chart review verification. The primary objective was to examine the role of serum albumin at time of presentation to MCC as a prognostic marker for overall survival (OS). Patients were divided into 3 groups of serum albumin levels (≤ 3.5, 3.6–4.0 and > 4.0 g/dl). The Kaplan–Meier method was used to estimate median OS. The log rank test was used to compare Kaplan–Meier survival estimates between two groups. Cox proportional hazards regression was used for multivariable analysis. Results: Between January 2001 and December 2009, 844 patients were captured by the MCC MDS database. The median age was 69 years. MDS subtypes were coded as refractory anemia (RA) (n=98;12%), refractory anemia with ring sideroblasts (RARS) (n=76;9%), del(5q) (n=20;2.4%), refractory cytopenia with multi-lineage dysplasia (RCMD) (n=96;11%), refractory anemia with excess blasts (RAEB) (n=255;30%), therapy related MDS (n=22;2.6%), and MDS-NOS (n=275; 33%). The distribution of IPSS risk groups was: 18.7% Low risk, 42.9% Intermediate-1 (Int-1), 19.9% Int-2, 5.3% High risk, and 13.2% unknown. Baseline characteristics for the three patient groups defined by serum albumin level are summarized in (Table-1). There was no difference in red blood cell transfusion dependency (RBC-TD) rate between the 3 groups (p=0.21). The median OS for all patients was 36 months (95% confidence interval (CI) 31.5–40.5 mo). Age, IPSS risk group, RBC-TD, Serum ferritin were statistically significant prognostic factors in univariable analysis. The median OS was 19 mo (95%CI= 14.9–23.1 mo), 35 mo (95%CI= 28.7–41.3 mo), and 53 mo (95%CI= 44.7–61.3 mo) for patients with serum albumin levels ≤ 3.5 g/dl, 3.6–4.0 g/dl, > 4.0 g/dl, respectively. (Figure-1) (p= <0.005). After adjustment for age, RBC-TD, OS was statistically significantly inferior among MDS patients with lower serum albumin (Hazard Ratio (HR) = 0.79.; 95%CI= 0.69–0.90; p= 0.001), and higher-risk IPSS group (HR=1.67; 95%CI=1.48-1.87; p= <0.005). The overall rate of AML transformation was 29.2%. Rate of AML transformation was higher in patients with lower serum albumin, 38% in patients with serum albumin ≤ 3.5 g/dl, 30% for patients 3.6–4.0 g/dl, and 23% in patients with serum albumin > 4.0 g/dl (p-value 0.005). Among patients in the Low/Int-1 IPSS risk group, the median OS was 28 mo (95%CI=15.7-40.3 mo), 48 mo (95%CI=38.8-58.0 mo), and 60 mo (95%CI=47.6-72.4 mo) for patients with serum albumin levels ≤ 3.5 g/dl, 3.6–4.0 g/dl and > 4.0 g/dl, respectively (p=0.003). Among patients in the Int-2/High IPSS risk group, the median OS was 16 mo (95%CI 13.3–15.7 mo), 22 mo (95%CI 18.0–26.0 mo), and 21 mo (95%CI 8.8–33.2 mo) respectively for patients with serum albumin levels ≤ 3.5 g/dl, 3.6–4.0 g/dl and > 4.0 g/dl, respectively p=0.03). Conclusion: In this retrospective analysis of a large single institution MDS database, serum albumin is found to be an independent prognostic factor for OS and AML transformation in MDS patients. The prognostic power of low serum albumin was greatest among patients with Low/Int-1 IPSS risk group, but remained an independent variable across all risk groups. Serum albumin may also be a surrogate marker of general health, co- morbidities, and performance status. Disclosures: No relevant conflicts of interest to declare.

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A prospective cohort study of hypoalbuminemia as risk factor of wound healing in diabetic foot: a study from tertiary hospital in south India

International Surgery Journal ◽

10.18203/2349-2902.isj20173903 ◽

2017 ◽

Vol 4 (9) ◽

pp. 3141

Author(s):

Unnikrishnan Edakkepuram ◽

Sheeja P. C. ◽

Ellikunnel Vithon Gopi

Keyword(s):

Wound Healing ◽

Risk Factor ◽

Cohort Study ◽

Serum Albumin ◽

Prospective Cohort Study ◽

Diabetic Foot ◽

Prospective Cohort ◽

Serum Albumin Level ◽

Albumin Level ◽

Low Serum

Background: Diabetic foot ulcers is a major complication of diabetes mellitus, and precedes >80% of all diabetes related lower leg amputations. One of the risk factors in non-healing diabetic ulcer is low serum albumin level. The objectives of this study were to study the effect of low serum albumin level in patients with diabetic foot ulcer and to study the factors affecting wound healing in diabetic ulcer.Methods: Prospective cohort study in a tertiary hospital.Results: The mean age among study was 57.8 out of which 68.3% were males and 31.7% were females. 55% patients presented with slough over ulcer, 29.2% patients presented with healthy granulation and 15.8% patients presented with extensive wound infection. Among study group 50% patients had good glycaemic control and 50% patients had poor glycaemic control.Conclusions: Low serum albumin level is one of the attributable risk factor of non-healing ulcers in diabetic foot. Poor glycaemic status is also a risk factor for non-healing ulcer.

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Serum albumin level for prediction of all-cause mortality in acute coronary syndrome patients: a meta-analysis

Bioscience Reports ◽

10.1042/bsr20190881 ◽

2020 ◽

Vol 40 (1) ◽

Cited By ~ 3

Author(s):

Lingjun Zhu ◽

Miaomiao Chen ◽

Xiaoping Lin

Keyword(s):

Acute Coronary Syndrome ◽

Serum Albumin ◽

Mortality Risk ◽

Serum Albumin Level ◽

Meta Analysis ◽

Albumin Level ◽

Coronary Syndrome ◽

All Cause Mortality ◽

The Impact ◽

Low Serum

Abstract The prognostic utility of serum albumin level as a predictor of survival in patients with acute coronary syndrome (ACS) has attracted considerable attention. This meta-analysis sought to investigate the prognostic value of serum albumin level for predicting all-cause mortality in ACS patients. A systematic literature search was conducted in Pubmed and Embase databases until 5 March 2019. Epidemiological studies investigating the association between serum albumin level and all-cause mortality risk in ACS patients were included. Eight studies comprising 21667 ACS patients were included. Meta-analysis indicated that ACS patients with low serum albumin level had an increased risk of all-cause mortality (risk ratio [RR] 2.15; 95% confidence interval [CI] 1.68–2.75) after adjusting for important covariates. Subgroup analysis showed that the impact of low serum albumin level was stronger in hospital mortality (RR 3.09; 95% CI 1.70–5.61) than long-term all-cause mortality (RR 1.75; 95% CI 1.54–1.98). This meta-analysis demonstrates that low serum albumin level is a powerful predictor of all-cause mortality in ACS patients, even after adjusting usual confounding factors. However, there is lack of clinical trials to demonstrate that correcting serum albumin level by means of intravenous infusion reduces the excess risk of death in ACS patients.

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Higher Rates of AML Transformation and Poor Risk Cytogenetics in Patients with Low Average Albumin Levels Confers Poor Prognosis in Myelodysplastic Syndromes,

Blood ◽

10.1182/blood.v118.21.3832.3832 ◽

2011 ◽

Vol 118 (21) ◽

pp. 3832-3832

Author(s):

Manoj Bupathi ◽

Valeria Visconte ◽

Fabiola Traina ◽

Mikkael A. Sekeres ◽

Jaroslaw P. Maciejewski ◽

...

Keyword(s):

Multivariate Analysis ◽

Serum Albumin ◽

Myelodysplastic Syndromes ◽

Serum Albumin Level ◽

Independent Predictor ◽

Albumin Level ◽

Categorical Variables ◽

Poor Risk ◽

Average Serum ◽

High Albumin

Abstract Abstract 3832 Myelodysplastic syndromes (MDS) represent a heterogeneous group of clonal disorders characterized by reduced hematopoiesis and progression to leukemia. Albumin is a prognostic biomarker in many malignant and non-malignant conditions, including multiple myeloma, chronic inflammation and aging. Recently, one study (Yepez, M, ASH 2010, abst #4001) showed that hypoalbuminemia was an independent prognostic factor in MDS. However, serum albumin levels can vary with time and be influenced by nutrition, age and presence of other comorbidities which are prevalent in MDS. To have an accurate assessment, we took the average serum albumin level of MDS patients over a period of 6 months. We hypothesize low average albumin will confer worse outcomes We conducted a retrospective analysis of 237 MDS patients seen in Cleveland Clinic between 1999 and 2009 (RARS= 30, RCMD=25, RAEB1/2=61, 5q- syndrome= 4, CMML1/2=39, MDS/MPN-U=32, RARS-T=30, RCUD=26). A total of 194 patients were included since average albumin was able to be calculated. The median age is 66 (20–92) years. Median follow-up time is 15 months (0–81 months). Clinical information including age, SNP-A karyotyping results, hemoglobin and serum albumin at time of diagnosis, average serum albumin level over 6 months, absolute neutrophil count, platelet counts, bone marrow blasts, and metaphase cytogenetic results were obtained.Patients were divided based on IPSS into lower and higher risk disease. We analyzed a total of 123 patients in the lower risk and 71 patients in the higher risk group. Further, we subdivided patients into lower albumin level (<3.5) or higher (3.5 or greater) based on the average albumin over 6 months. The median overall survival (OS) of the cohort is 15 months. Categorical variables were analyzed using Fisher's exact test. The Cox-proportional hazards model was used to assess univariate and multivariate analyses for OS and progression free survival (PFS); factors assessed included age (≥60 vs. <60 years), disease grouping (MDS and MDS/MPN vs sAML), BM blasts (≥5 vs. <5 %), Hgb level (≥10 vs. <10 g/dL), metaphase cytogenetics (MC) risk groups using IPSS criteria (good, intermediate, poor), presence or absence of new SNP lesions and average albumin level. Each variable was retained in the multivariate model regardless of its statistical significance. Only variables with p<.05 in multivariate analysis were considered significant. Similar to the study by Yepez M et al, we also found that serum albumin level at the time of original diagnosis is prognostic in MDS and related disorders. Patients with low albumin levels at diagnosis (<3.5) have a worse OS compared to those with high albumin levels (6 vs 16 mos, p=.005). However, this was possible with a dichotomized albumin level. More importantly, we also found that the lower average serum albumin level [OS (8 vs 30 mos, p=.0001) and PFS (5 vs 20 mos, p=<.0001)] over 6 months can also be prognostic in MDS but not in MDS/MPN and sAML. Patients with low average albumin have poorer survival compared to patients with high albumin (OS: 6 vs 23 months, p=<.0001; PFS: 5 vs 15 months, p= <.0001). The same statistically significant findings were observed in patients stratified to lower (OS: 9 vs 37 mos, p=.001; PFS: 5 vs 24 mos, p=<.0001) or higher (5 vs 13 mos, p=.03) risk MDS by IPSS. Multivariate analysis showed that low average albumin level is an independent predictor of poor outcomes in MDS (OS: HR=2.12 CI:1.53–2.99, p=<.0001; PFS: HR=1.91 CI:1.31–2.76, p=.0009). Similarly, previously validated poor prognostic factors in MDS remained significant (Age ≥60 [HR:1.87, p=.0003], sAML disease grouping [HR:2.08, p=.0001], Hgb <10 g/dl [HR:1.42, p=.009], BM blasts [HR:1.44, p=.03], Poor risk cytogenetics [HR:2.22, p=.004], and presence of new SNP lesions [HR:1.59, p=.0008]. To identify factors that may result in worse outcomes in low average albumin patients, we assessed treatment response differences between patients which were not significant between low and high albumin levels. However AML transformation [(42/92 (45%) vs 111/150 (74%), p.002] and cytogenetics [Poor vs Good/Intermediate (21/43 (49%) vs 55/185 (30%), p=.02)] correlated with lower average albumin levels. In conclusion, low average serum albumin levels are an independent predictor of worse outcomes in MDS. Moreover, these data suggest that low average serum albumin is associated with poor risk karyotype and with progression to AML. Disclosures: No relevant conflicts of interest to declare.

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Association of a high normalized protein catabolic rate and low serum albumin level with carpal tunnel syndrome in hemodialysis patients

Medicine ◽

10.1097/md.0000000000004050 ◽

2016 ◽

Vol 95 (26) ◽

pp. e4050 ◽

Cited By ~ 1

Author(s):

Wen-Hung Huang ◽

Ching-Wei Hsu ◽

Cheng-Hao Weng ◽

Tzung-Hai Yen ◽

Jui-Hsiang Lin ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Serum Albumin ◽

Carpal Tunnel ◽

Serum Albumin Level ◽

Hemodialysis Patients ◽

Albumin Level ◽

Catabolic Rate ◽

Tunnel Syndrome ◽

Protein Catabolic Rate ◽

Low Serum

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AB0424 PREDICTORS OF SLE FLARE-UP AND PREMATURE DELIVERY IN PREGNANCY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2904 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1511.1-1512

Author(s):

C. H. Liao ◽

L. C. Wang ◽

S. C. Hsieh ◽

B. L. Chiang

Keyword(s):

Serum Albumin ◽

Serum Albumin Level ◽

Post Partum ◽

First Trimester ◽

Albumin Level ◽

Complement C3 ◽

Premature Delivery ◽

Disease Flare ◽

In Pregnancy ◽

Low Serum

Background:Systemic lupus erythematosus (SLE) is a life-threatening autoimmune disease that affects many women of child-bearing age, with potentially severe consequences on pregnancy outcome. SLE flare-ups may occur during pregnancy and the post-partum period. Previous studies documenting the incidence and risk factors of flare-up of SLE during pregnancy and puerperium had partially discordant results.Objectives:We aimed to delineate the pregnancy complications of women with SLE, as well as neonatal outcomes of their offspring, and hoped to clarify the incidence and risk factors of SLE flare-ups during pregnancy and puerperium.Methods:We retrospectively reviewed the medical records of SLE patients with previous records of pregnancies in our institution. Flare events during pregnancy and puerperium were documented. The pregnancy outcomes recorded include live births, intra-uterine fetal death (IUFD), premature delivery (< 36 weeks of gestational age), NICU admission, and small for gestational age (SGA, <10thpercentile). Univariate logistic regression was performed to determine the factors associated with disease relapse and pregnancy outcomes.Results:From January, 2000 to December, 2019, a total of 94 SLE patients with 139 pregnancies were identified. The overall live birth rate was 92.4% (134/145). Forty-six (34.3%) of the neonates were delivered prematurely. Forty-six (34.3%) of them were SGA. The admission rate to the neonatal intensive care unit was 25% (30/120). Nine (6.4%) were diagnosed to have SLE during pregnancy. The flare rate during pregnancy was 20% while post-partum 9.4%. The majority of the relapses during pregnancy occurred in the second trimester (46.2%), followed by the first trimester (30.8%), and the third trimester (23.1%). Low complement C3 (C3 < 80mg/dl), thrombocytopenia (PLT < 100*103/uL) at conception, and low serum albumin level at the first trimester were associated with antepartum flare. Presence of disease flare and pre-eclampsia in pregnancy, and low serum albumin level at conception were significantly associated with premature delivery.Conclusion:Low complement C3 and thrombocytopenia at conception, and low serum albumin level at the first trimester were associated with disease flare-up during pregnancy. Patients with relative low serum albumin level at conception, or presence of eclampsia or disease flare-up during pregnancy had a higher risk of premature delivery.References:[1]Shaharir SS, Mohamed Said MS, Mohd R, et al. Predictors of SLE relapse in pregnancy and post-partum among multi-ethnic patients in Malaysia.PloS one2019;14(9):e0222343.[2]Bundhun PK, Soogund MZ, Huang F. Impact of systemic lupus erythematosus on maternal and fetal outcomes following pregnancy: A meta-analysis of studies published between years 2001-2016.Journal of autoimmunity2017;79:17-27.Disclosure of Interests: :None declared

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