Rp. Ferguson et al., SERUM-ALBUMIN AND PREALBUMIN AS PREDICTORS OF CLINICAL OUTCOMES OF HOSPITALIZED ELDERLY NURSING-HOME RESIDENTS, Journal of the American Geriatrics Society, 41(5), 1993, pp. 545-549
Objective: To investigate the prevalence of hypoalbuminemia and hypopr
ealbuminemia in hospitalized, elderly, skilled nursing facility reside
nts and to correlate these findings with clinical outcomes. Design: Pr
ospective cohort study. Setting: A 300-bed community hospital. Partici
pants: Eighty-one hospitalized, skilled nursing facility patients, ave
rage age 83.1 years. Interventions: None. Outcome Measures: Serum albu
min and prealbumin (transthyretin) were measured at admission, mid-wee
k, 1 week, and 1 month. Patients were followed for 90 days for the out
comes of length of hospitalization and mortality. Results: The prevale
nce of hypoalbuminemia was 99% and of hypoprealbuminemia, 79%. Both me
ans dropped significantly from admission to midweek nadirs of 25 g/L f
or albumin and 14 mg/L for prealbumin. Severe hypoalbuminemia at mid-w
eek predicted mortality (RR = 4.1 95%, CI 2.0-8.5) and extended length
of hospitalization (RR = 5.2 95%, CI 2.8-9.8). Severe hypoprealbumine
mia predicted extended hospitalization (RR = 3.2, CI 1.5-6.7) but not
mortality. Conclusions: Hypoalbuminemia and hypoprealbuminemia are ver
y common in this clinical setting and vary in parallel fashion over ti
me. Severe hypoalbuminemia was a stronger predictor than hypoprealbumi
nemia of 90-day mortality and extended length of stay. Serum albumin o
n admission was not as strong a predictor of outcomes as serum albumin
at mid-week.