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Cited by 88Clinical Nutrition and GastroenterologyNutrition and Health in AgingDialysis and Renal Disease Management

Admission serum albumin concentrations and response to nutritional therapy in hospitalised patients at malnutrition risk: Secondary analysis of a randomised clinical trial

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Bretscher, Céline, Boesiger, Fabienne, Kaegi-Braun, Nina, Hersberger, Lara, Lobo, Dileep N., Evans, David C., Tribolet, Pascal, Gomes, Filomena +14 more·2022·eClinicalMedicine
DOI 10.1016/j.eclinm.2022.101301PMC PMC8844847
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Abstract

Background Historically, admission serum albumin concentrations have been considered useful biochemical markers for nutrition assessment. However, there is a lack of randomised trial data investigating whether low albumin concentrations are helpful for identifying patients benefitting from nutritional support. Methods This study was a secondary analysis of the EFFORT trial, a Swiss-wide multicentre, randomised controlled trial comparing individualised nutritional support with usual care nutrition in medical inpatients from April 1, 2014, to February 1, 2018. 1389 of 2028 patients at nutritional risk with available albumin concentrations on admission were included. The primary endpoint was all-cause mortality within 30 and 180 days. Patients were stratified into groups of low or normal albumin based on the albumin cut-off of 30 g/L. ClinicalTrials.gov number, NCT02517476. Findings 1389 patients (mean age, 73.1 (SD 3.5) years; 747 (53.8%) men) were included and 676 (48.7%) had low serum albumin concentrations at admission (<30 g/L). Mortality at 180 days was significantly increased in the low albumin group compared with patients with normal albumin concentrations (219/676 (32.4%) vs. 162/713 (22.7%), fully adjusted HR 1.4, 95%CI 1.11 to 1.77, p = 0.005]. Effects of nutritional support on 30-day mortality were similar for patients with low compared to patients with normal albumin concentrations (HR 0.68, 95%CI 0.44 to 1.05 vs. HR 0.70, 95%CI 0.41 to 1.20), with no evidence for a subgroup effect ( p for interaction=0.97). Interpretation Based on this secondary analysis of a randomised trial, low admission serum albumin concentrations in hospitalised, non-critically ill, medical patients at nutritional risk had prognostic implications and indicated higher mortality risk but were not helpful in selecting patients for nutritional interventions. Funding The Swiss National Science Foundation (SNSF) (PP00P3_150531) and the Research Council of the Kantonsspital Aarau (1410.000.058 and 1410.000.044) provided funding for the EFFORT trial

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  • Albumin and prealbumin levels have a strong prognostic value but little correlation with nutritional response.

    “Albumin and prealbumin levels also have a strong prognostic value, but little correlation with nutritional response [192,193] (both Level of evidence 1þþ).”

    From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [192]

    The Discussion reports that admission albumin was a strong prognostic indicator and that response to nutritional support was independent of albumin concentration. It does not establish the same findings for prealbumin; the Discussion instead proposes studying prealbumin in future research. (LLM, conf=0.90)

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Authors
Bretscher, C., Boesiger, F., Kaegi-Braun, N., Hersberger, L., Lobo, D. N., Evans, D. C., Tribolet, P., Gomes, F., Hoess, C., Pavlicek, V., Bilz, S., Sigrist, S., Brändle, M., Henzen, C., Thomann, R., Rutishauser, J., Aujesky, D., Rodondi, N., Donzé, J., Stanga, Z., Mueller, B., & Schuetz, P.
Affiliations
  • Kantonsspital Aarau (CH)
  • Nottingham University Hospitals NHS Trust (GB)
  • OhioHealth (US)
  • Bern University of Applied Sciences (CH)
  • New York Academy of Sciences (US)
  • Kantonsspital Münsterlingen (CH)
  • Kantonsspital St. Gallen (CH)
  • Luzerner Kantonsspital (CH)
  • Kantonsspital Baselland Standort Bruderholz (CH)
  • University of Bern (CH)
  • Brigham and Women's Hospital (US)
ORCID
Venue
eClinicalMedicine
Publisher
Elsevier BV
Published
2022-03
Volume
45
Pages
101301
ISSN
2589-5370 (ISSN-L)
DOI
10.1016/j.eclinm.2022.101301
PMC
PMC8844847
OpenAlex
W4211166792
Cited by
88
References
10
Citations by year
2026: 14 · 2025: 19 · 2024: 28 · 2023: 19 · 2022: 8
FWCI
10.86
Type
journal article
Language
en
Open access
Licence
Locations
  • EClinicalMedicine (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by-nc-nd)
  • ARBOR - Bern University of Applied Sciences Repository (submittedVersion, other-oa)
  • Bern Open Repository and Information System (University of Bern) (submittedVersion, cc-by-nc-nd)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • BFH: ARBOR
  • Open Access CRIS of the University of Bern
Funders
Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (PP00P3_150531)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
Keywords
serum albumin, low albumin, nutritional risk, nutritional support, nutritional therapy, all-cause mortality, prognostic factors, malnutrition

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