Role of hypoalbuminemia and hypocholesterolemia as copredictors of mortality in acute renal failure

Background. Hypoalbuminemia(LA) and hypocholesterolemia (LC) have been repo rted to portend high mortality in both older patients and in patients with end-stage renal disease. Even though low levels have been reported in criti cally ill patients, they have not been clearly defined as predictors of mor tality in acute renal failure (ARF). The impact of LA and LC on mortality i n ARF is evaluated in this study. Methods. We conducted a computer-assisted three-year retrospective review o f all cases of ne novo ARF seen at an inner city tertiary-cart facility. On e hundred cases met the criteria for inclusion in the study. We employed bo th univariate and multivariate logistic regression models to estimate the r elative risks (RR) and 95% confidence intervals (CI) of mortality associate d with several variables. Results. Predictors associated with a high risk of death identified in this study include LC less than or equal to 150 mg/dl (less than or equal to 3. 9 mmol/liter; RR, 7.4; CI, 2.7 to 20.3), LA less than or equal to 35 g/lite r (RR, 5.0; CI, 1.9 to 13.2), sepsis (RR, 9.4; CI, 3.7 to 23.9), mechanical ventilation (RR, 10.8; CI, 2.8 to 41.0), oliguria (RR 17.0; CI, 6.2 to 46. 6), and multisystem organ failure (RR 24.7; CI, 10.3 to 59.1), The overall gross mortality was 39%,but mortality among intensive care unit patients wa s 82%. Survival was 82% among patients with serum albumin > 35 g/liter vers us 48% among those with serum albumin less than or equal to 35 g/liter (chi (2)? = 11.9, P = 0.0006). Similarly, survival was higher among patients wit h cholesterol > 150 mg/dl (> 3.9 mmol/liter) than those whose levels were l ess than or equal to 150 mg/dl (less than or equal to 3.9 mmol/liter; 85 vs . 44%,chi(2) = 17.3, P < 0.0001). Significant association between LA and LC was observed (R = 0.4, P < 0.0001). Age, gender, level of plasma creatinin e, and underlying chronic medical conditions were not predictive of mortali ty. Conclusion. Survival in ARF is significantly altered by the levels of album in and cholesterol. Because both LC and LA can be cytokine mediated, their presence in ARF should be considered ominous.