Serum Albumin Level < 32 g/l on Day 30 Can Predicts Higher Risk of Non-Relapse Mortality in Acute Lymphoblastic Leukemia Following Allogeneic Stem Cell Transplantation

Introduction: It is extremely significant issue to predict hematopoietic stem cell transplant (HSCT) outcomes using a biomarker. In this study, we attempted to evaluate the impact of post-transplant serum albumin on outcomes in patients with acute lymphoblastic leukemia (ALL). Methods: 123 patients with ALL receiving HSCTs between 1999 and 2012 at our center were evaluated for post-transplant serum albumin levels and their correlation with transplant's outcome. The level of serum albumin was retrospectively retrieved in certain time point ± 3 days for following periods: 1 month pre HSCT and then weekly after transplantation for first 3 months. 100 patients had available serum albumin levels. The ROC analyses were used to determine the most statistically significant cutoff level of serum albumin level correlating with NRM at 1 year. The ROC analysis suggested the level of 32 g/l at 4 weeks post HSCT as the best cutoff level for further analysis. Thus patients were stratified into low versus high albumin level group according to that cutoff level. Results: Median age for all patients is 37 (range 17-61), 35% were female and related donors were 57%. Matched donors were 83%. 71% were in 1st complete remission. 37% were Philadelphia chromosome positive. GVHD prophylaxis was CSA/MTX 60%, CSA/MMF 22%. Conditioning regimen was myeloablative in 95%. 61% received peripheral blood stem cells. With a median follow-up among survivors of 60 months (range 21-100), 61% patients showed albumin level ³ 32g/l at day 30 while 39% showed dropped albumin level <32 g/l at day 30. The OS rate at 2 years was 61% in high albumin group versus 23% in low albumin group (p < 0.001). The NRM rate was 62% in high albumin group versus 17% in low albumin group (p < 0.001). However, no difference of relapse incidence was noted between the two groups. The cumulative incidence of overall acute GVHD, grades 2/4, grades 3/4 at day 120 and overall chronic GVHD at 2 years was 67%, 59%, 16% and 45% in high albumin group versus 72%, 70%, 49% and 39% in low albumin group, suggesting higher incidence of grade 3/4 acute GVHD in low albumin group vs high. In multivariate analysis, serum albumin level < 32 g/l at 4 weeks was confirmed as an independent adverse risk factor for NRM (p=0.04, HR 2.81) together with acute GVHD grades 3/4 (p 0.01, HR 3.79) and chronic GVHD (p²0.001, HR 0.21). For OS, albumin level was not confirmed as an independent risk factor, but acute GVHD grade 3/4 (p< 0.001, HR 3.36) and chronic GVHD (p <0.001, HR 0.008) were found to be independent factors. For relapse chronic GVHD grade 3-4 was the only independent prognostic factor (p <0.001, HR 0.27). Conclusion: The present study suggested that 1) serum albumin level less than 32 g/l at day 30 can predicts higher risk of non-relapse mortality and 2) dropped serum albumin might be affected by in part the occurrence of severe acute GVHD, and by independent mechanism of gut GVHD. Further study is strongly warranted to confirm the prognostic role of serum albumin level on transplant outcomes in a prospectively designed study. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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Low Serum Albumin Level is Risk Factor for Patients with Percutaneous Endoscopic Gastrostomy

Internal Medicine ◽

10.2169/internalmedicine.49.3057 ◽

2010 ◽

Vol 49 (21) ◽

pp. 2283-2288 ◽

Cited By ~ 17

Author(s):

Naoyuki Tominaga ◽

Ryo Shimoda ◽

Ryuichi Iwakiri ◽

Nanae Tsuruoka ◽

Yasuhisa Sakata ◽

...

Keyword(s):

Risk Factor ◽

Serum Albumin ◽

Percutaneous Endoscopic Gastrostomy ◽

Serum Albumin Level ◽

Albumin Level ◽

Endoscopic Gastrostomy ◽

Low Serum

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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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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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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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Postoperative serum albumin level is an independent risk factor for discontinuation of adjuvant chemotherapy for pancreatic cancer

Pancreatology ◽

10.1016/j.pan.2013.07.199 ◽

2013 ◽

Vol 13 (4) ◽

pp. S51

Author(s):

Masaki Tanaka ◽

Ippei Matsumoto ◽

Makoto Shinzeki ◽

Sadaki Asari ◽

Tadahiro Goto ◽

...

Keyword(s):

Pancreatic Cancer ◽

Risk Factor ◽

Adjuvant Chemotherapy ◽

Serum Albumin ◽

Independent Risk Factor ◽

Serum Albumin Level ◽

Albumin Level ◽

Postoperative Serum

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Prognostic factor of the two-year mortality after revascularization in patients with critical limb ischemia

Vascular ◽

10.1177/1708538116651216 ◽

2016 ◽

Vol 25 (2) ◽

pp. 123-129 ◽

Cited By ~ 4

Author(s):

Koichi Morisaki ◽

Takuya Matsumoto ◽

Yutaka Matsubara ◽

Kentaro Inoue ◽

Yukihiko Aoyagi ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ejection Fraction ◽

Serum Albumin ◽

Critical Limb Ischemia ◽

Serum Albumin Level ◽

Limb Ischemia ◽

Albumin Level ◽

Surgical Revascularization ◽

Hybrid Therapy

Purposes The aim of this study was to evaluate the risk factors for the two-year survival after revascularization of critical limb ischemia. Methods Between 2008 and 2012, 142 patients underwent revascularization. A retrospective analysis was performed to measure the risk factor. Results A total 85 patients underwent surgical revascularization, 31 patients underwent endovascular therapy while 26 patients underwent hybrid therapy. By multivariate analysis, the following variables were considered to be risk factors: ejection fraction <50 % (HR, 3.14; 95% CI, 1.22–7.95; P = 0.02), serum albumin level <2.5 g/dL (HR, 3.45; 95% CI, 1.01–11.7; P = 0.04) and nonambulatory status (HR, 4.11; 95% CI, 1.79–9.70; P < 0.01). The two-year survival rate of the patients with no risk factors was 85.5%, while the patients with at least one risk factor had an unfavorable prognosis (one; 56.7%, two; 45.4%). Conclusions The nonambulatory status, serum albumin level <2.5 g/dL and ejection fraction <50% were the risk factors for the two-year mortality after revascularization in critical limb ischemia patients. These risk factors may be useful for the treatment strategy of critical limb ischemia patients.

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Early Recovery Of Absolute Lymphocyte Counts ≥ 0.2x109/L At Day 21 Can Predict Reduced Risk Of Relapse In Acute Lymphoblastic Leukemia Following Allogeneic Stem Cell Transplantation

Blood ◽

10.1182/blood.v122.21.3392.3392 ◽

2013 ◽

Vol 122 (21) ◽

pp. 3392-3392

Author(s):

Feras Abdulaziz Alfraih ◽

Dennis Dong Hwan Kim ◽

John Kuruvilla ◽

Hans A. Messner ◽

Jeffrey H. Lipton ◽

...

Keyword(s):

Overall Survival ◽

Stem Cell ◽

Acute Lymphoblastic Leukemia ◽

Acute Gvhd ◽

Lymphoblastic Leukemia ◽

Chronic Gvhd ◽

Early Recovery ◽

Recovery Group ◽

Absolute Lymphocyte Counts ◽

Grade 3

Abstract Introduction Predicting transplant’s outcome has been an important issue. Many factors have been elucidated. We evaluated impact of lymphocyte counts on transplant outcome including relapse in patients with acute lymphoblastic leukemia. Methods A total of 117 patients with acute lymphoblastic leukemia receiving hematopoietic stem cell transplants (HSCTs) between year 1999 and 2012 at Princess Margaret Hospital, Toronto, Canada were evaluated for the occurrence of early recovery of absolute lymphocyte counts (ALC) and their impact on transplant’s outcome. Patients who received T cell depletion were excluded from analysis, a total of 94 cases were finally included in the analysis. ALCs were regularly monitored on daily basis for first 28 days. Results Sixty two patients (66%) were matched related donor and 31 (33%) were female. Seventy one patients (75%) were in 1st complete remission (CR1) versus 23 (25%) beyond CR1. Thirty four patients (64%) were Philadelphia chromosome positive. GVHD prophylaxis was CSA/MMF (n=28, 30%), CSA/MTX (n=64, 68%), other (n=2, 2%). Conditioning regimen was myeloablative in 91 patients (97%) versus reduced intensity in 3 patients (3%). Fifty eight patients received peripheral blood stem cells as a stem cell source. Different cut offs of ALCs including 0.2, 0.3, 0.5 and 1.0x109/L at day 21 and day 28 were evaluated for transplant outcomes in order to select the best cut off of ALC recovery. We selected ALC 0.2x109/L at day 21 as a cutoff of ALC recovery based on the p-value. With a median follow-up of 60 months for survivors (range 2 to 116.5 months), 71 patients (75%) showed early recovery of ALC at day 21 (i.e. patients with ALC ≥ 0.2 x109/L at day 21), while 23 patients did not reach 0.2x109/L of ALC at day 21 (i.e. patients with ALC ≤ 0.2 x109/L at day 21). The overall survival (OS) and non-relapse mortality (NRM) were not significantly different between the groups: for 3 years OS rate, 47% in early ALC recovery group vs 35% in late ALC recovery group (p=0.35 ); for 3 year NRM rate, 38% in early ALC recovery group vs 26% in late ALC recovery group (p =0.33 ). However, a lower incidence of relapse was observed in early ALC recovery group (17%) compared to late ALC recovery group (39% at 3 years; p=0.005). The cumulative incidence of acute GVHD grades 2 to 4, grades 3/4 at day 120 and overall chronic GVHD at 2 years was 62%, 32% and 45% for patients with ALC ≥ 0.2 x109/L versus 65%, 25% and 39% for those with ALC ≤ 0.2 x109/L at day 21. CMV viraemia rate was 44% versus 43% in early versus late ALC recovery groups. The median time to neutrophil and platelet engraftment was 16 and 12 days in early ALC recovery group versus 23 and 21 days in late ALC recovery group. In multivariate analysis, ALC ≥ 0.2 x109/L at day 21 was an independent favorable risk factor for relapse (p=0.017, Hazard ratio [HR] 0.183) together with chronic GVHD (p≤0.001, HR 0.058). For overall survival, acute GVHD grade 3-4 (p=0.03, HR 2.857), chronic GVHD (p=0.001, HR 0.103) and age as continuous variable (p=0.05, HR 1.04) were independent factors. For NRM acute GVHD grade 3-4 was the only independent prognostic factor (p=0.006, HR 6.896) Conclusion Early recovery of absolute lymphocyte counts ≥0.2x109/L at day 21 can predict reduced relapse risk in ALL patients following allogeneic stem cell transplantation. The impact of lymphocyte counts on overall survival and non-relapse mortality was not statistically significant. Disclosures: No relevant conflicts of interest to declare.

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Multiple CMV Reactivations Are Associated with Lower Risk of Relapse Following Reduced Intensity Conditioning Allogeneic Stem Cell Transplantation

Blood ◽

10.1182/blood.v124.21.3955.3955 ◽

2014 ◽

Vol 124 (21) ◽

pp. 3955-3955

Author(s):

Feras Alfraih ◽

Naheed Alam ◽

Vikas Gupta ◽

Dennis Dong Hwan Kim ◽

John Kuruvilla ◽

...

Keyword(s):

Stem Cell ◽

Lower Risk ◽

Independent Risk Factor ◽

Acute Gvhd ◽

Chronic Gvhd ◽

Group Versus ◽

Transplant Outcomes ◽

Grade 3 ◽

Reduced Intensity ◽

Risk Of Relapse

Abstract Introduction : Cytomegalovirus (CMV) is a major infectious complication following allogeneic hematopoietic stem cell transplantation (HSCT). In this study, we attempted to evaluate the impact of multiple versus single CMV viremia (CMV-V) events on transplantÕs outcomes especially with respect to relapse, non-relapse mortality (NRM) and overall survival (OS). Methods : A total of 548 patients were evaluated for the occurrence of CMV-V after receiving HSCT between 2005 and 2012 at Princess Margaret Cancer Centre. CMV-V was diagnosed in peripheral blood samples obtained on two occasions either by PCR (³ 200 IU/ml) or antigenemia testing (³2 positive cells/100000). A total of 246 patients developed CMV-V and were included in the analysis. Patients were stratified into two groups, multiple CMV-V (³ 2) versus single CMV-V. Median age for all patients is 52 (range 17-71) and 125 (51%) were female. Matched related donors were used for one hundred twenty-five patients (57%). One hundred fifty-six patients (64%) were transplanted for myeloid and 70 (29%) for lymphoid malignancies. Ninety-seven patients (30%) were CMV sero-positive with a negative donor (R+D-) while 138 (51%) were recipient and donor CMV sero-positive (R+D+). Graft versus host disease (GVHD) prophylaxis included CSA/MMF (n=131, 53%) and CSA/MTX (n=115, 47%). Myeloablative conditioning regimens were administered to 143 patients (58%), 103 patients (42%) were treated with a reduced intensity regimen (RIC). Two hundred-fifteen patients (89%) received peripheral blood stem cells as a stem cell source. In- vivo T-cell depletion (TCD) with alemtuzumab was used in 103 (53%). Results: With a median follow-up duration of 27 months among survivors (range 6-92), overall CMV-V occurred in 64% (n=246). Multiple CMV-V occurred in 61% (n=151) versus 39% (n=95) in single CMV-V. The cumulative incidence of grades 1-4 acute GVHD, grades 2-4, grades 3-4 at day 120 and overall chronic GVHD at 2 years was 78%, 61%, 27% and 60% in the multiple CMV-V group versus 54%, 43%, 18% and 39% in single CMV-V group, suggesting higher incidence of acute & chronic GVHD in multiple CMV-V group versus single-CMV-V. The OS, NRM and relapse rate at 2 years were 47%, 41% and 14% in the multiple CMV-V versus 41%, 36% and 24% (p=0.06) in single CMV-V group, suggesting no differences on transplant outcomes between both groups. Sub-analyses based on preparative regimen administered showed, in RIC patients there were significant differences on relapse and NRM between multiple CMV-V versus single CMV-V (table 1) while in myeloablative set, these differences were not seen. The higher incidences of acute and chronic GVHD in patients with multiple CMV-V versus single-CMV-V events were similar on both RIC and myeloablative sets. Table 1. Transplant outcomes according to the occurrence of CMV infection following RIC allogeneic HSCT Overall Multiple CMV-V Single CMV-V (n=103, 100%) (n=57, 55%) (n=46, 45%) p-value Acute GVHD Grades 1-4 64 (62%) 39 (68%) 25 (54%) 0.158 Grades 2-4 46 (45%) 31 (54%) 15 (33%) 0.030 Grades 3-4 14 (14%) 11 (19%) 3 (7%) 0.083 CGVHD, overall 52 (50%) 34 (60%) 18 (39%) 0.048 Transplant outcomes Death 55 (53%) 30 (53%) 25 (54%) 1.000 Non-relapse mortality 33 (32%) 23 (40%) 10 (22%) 0.057 Relapse 23 (22%) 7 (12%) 16 (35%) 0.009 A multivariate analysis in patients conditioned with RIC for transplant outcomes, confirmed multiple CMV-V as an independent protective factor for relapse (p=0.03, Hazard ratio [HR] 0.32) together with chronic GVHD (p< 0.01, HR 0.27) and myeloid disease (p=0.02, HR 2.46). For NRM, multiple CMV-V was not confirmed as an independent risk factor, but acute GVHD grade 3-4 (p< 0.01, HR 5.33) and chronic GVHD (p <0.01, HR 0.34) were found to be significant factors. For OS, chronic GVHD (p<0.01, HR 0.27), grade 3-4 (<0.01, HR 3.52) and age (P<0.01, HR 1.06) were independent prognostic factors. Conclusion: 1) Multiple CMV-V after RIC allogeneic HSCT is associated with significantly lower risk of relapse mortality, which might be affected in part by the occurrence of severe acute and chronic GVHD, and by other unknown independent mechanisms related to CMV infections. 2) CMV sero-status was not an independent risk factor for transplant outcomes in patients with CMV-V. 3) Further studies in larger populations are warranted to confirm and further explore a possible anti-tumor effect of cytomegalovirus infections especially in patients prepared with RIC. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

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Serum albumin and beta-amyloid deposition in the human brain

Neurology ◽

10.1212/wnl.0000000000010005 ◽

2020 ◽

Vol 95 (7) ◽

pp. e815-e826

Author(s):

Jee Wook Kim ◽

Min Soo Byun ◽

Jun Ho Lee ◽

Dahyun Yi ◽

So Yeon Jeon ◽

...

Keyword(s):

Confidence Interval ◽

Serum Albumin ◽

Human Brain ◽

Odds Ratio ◽

Serum Albumin Level ◽

Continuous Variable ◽

Albumin Level ◽

Cerebral White Matter ◽

Low Serum ◽

High Albumin

ObjectivesTo investigate the relationships of serum albumin with in vivo Alzheimer disease (AD) pathologies, including cerebral β-amyloid (Aβ) protein deposition, neurodegeneration of AD-signature regions, and cerebral white matter hyperintensities (WMH), in the human brain.MethodsA total of 396 older adults without dementia underwent comprehensive clinical assessments, measurement of serum albumin level, and multimodal brain imaging, including [11C] Pittsburgh compound B-PET, 18F-fluorodeoxyglucose-PET, and MRI. Serum albumin was categorized as follows: <4.4 g/dL (low albumin), 4.4 to 4.5 g/dL (middle albumin), and >4.5 g/dL (high albumin; used as a reference category). Aβ positivity, AD-signature region cerebral glucose metabolism (AD-CM), AD-signature region cortical thickness (AD-CT), and WMH volume were used as outcome measures.ResultsSerum albumin level (as a continuous variable) was inversely associated with Aβ deposition and Aβ positivity. The low albumin group showed a significantly higher Aβ positivity rate compared to the high albumin group (odds ratio 3.40, 95% confidence interval 1.67–6.92, p = 0.001), while the middle albumin group showed no difference (odds ratio 1.74, 95% confidence interval 0.80–3.77, p = 0.162). Neither serum albumin level (as a continuous variable) nor albumin categories were related to AD-CM, AD-CT, or WMH volume.ConclusionsLow serum albumin may increase the risk of AD dementia by elevating amyloid accumulation. In terms of AD prevention, more attention needs to be paid to avoid a low serum albumin level, even within the clinical normal range, by clinicians.

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