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Albumin Synthesis Rates Are Not Decreased in Hypoalbuminemic Cachectic Cancer Patients With an Ongoing Acute-Phase Protein Response
Open accessAbstract
OBJECTIVE: To determine whether suppression of albumin synthesis contributes to the hypoalbuminemia observed in weight-losing cancer patients with evidence of an ongoing acute-phase protein response (APPR). BACKGROUND DATA: Proinflammatory cytokines such as tumor necrosis factor (TNF) and interleukin 6 (IL-6) are known to downregulate albumin synthesis and increase acute-phase protein production in isolated hepatocytes. However, whether albumin synthesis is suppressed in hypoalbuminemic cancer patients with evidence of an ongoing acute-phase response is unknown. METHODS: Albumin synthesis rates were determined in six healthy controls and in six weight-losing pancreatic cancer patients with an ongoing APPR using a flooding dose technique with [2H5]-phenylalanine. The presence of an APPR was defined as a serum C-reactive protein concentration >10 mg/L. Serum cytokines (TNF, IL-6) and soluble TNF receptors (sTNF-R 55 and 75), along with serum cortisol and insulin, were also measured in both groups. RESULTS: Cancer patients had reduced serum albumin (median 32 [range, 23-36] vs. 42 g/L [40-45]; p < 0.01) and increased serum C-reactive protein concentrations (72 [23-126] vs. <5 mg/L; p < 0.01) when compared with controls. TNF was not detected in either group. sTNF-R 55 levels were significantly elevated in the cancer patients (3.8 [1.9-8.1] vs. 1.2 pg/mL [0.9-2.2]; p < 0.01). Circulating IL-6, insulin, and cortisol concentrations were not significantly different between the groups. The intravascular albumin mass was lower (88 [56-93] vs. 133 g [105-177]; p < 0.01), but the intravascular albumin fractional synthetic rate was higher (13.9 [13.5-18.5] vs. 10.3%/d [71-11.3]; p < 0.01) in the cancer patients compared with the controls. The total intravascular albumin synthetic rate was, however, similar between the two groups (12.7 [7.7-15.7] vs. 11.7 g/d [8.5-18.7]; p NS). CONCLUSIONS: In weight-losing pancreatic cancer patients with evidence of an ongoing APPR, hypoalbuminemia is not caused by a decreased rate of albumin synthesis.
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“However, in most disease states in which synthesis rates have been measured, fractional synthesis rate (FSR) in plasma has been reported to be normal or mildly increased (Table 1).63, 64, 65, 66, 67, 68, 69, 70, 71”
From Hypoalbuminemia: Pathogenesis and Clinical Significance (2019) · cites this paper as [66]
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“In clinical practice, all acutely ill or (surgically) traumatized patients have low serum albumin levels.66, 67, 68, 69, 98, 99, 100”
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Metadata
- Authors
- Fearon, K. C. H., Falconer, J. S., Slater, C., McMillan, D. C., Ross, J. A., & Preston, T.
- Affiliations
- Edinburgh Royal Infirmary (GB)
- Scottish Universities Environmental Research Centre (GB)
- Glasgow Royal Infirmary (GB)
- Corresponding author
- Fearon, Kenneth C. H.
- Falconer, J. Stuart
- Ross, James A.
- Venue
- Annals of Surgery
- Published
- 1998-02
- Volume
- 227
- Issue
- 2
- Pages
- 249-254
- ISSN
- 0003-4932 (ISSN-L)
- PMC
- PMC1191243
- OpenAlex
- W2068129622
- Cited by
- 196
- References
- 31
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 5 · 2023: 6 · 2022: 9 · 2021: 12 · 2020: 5 · 2019: 9 · 2018: 5 · 2017: 4 · 2016: 13 · 2015: 10 · 2014: 5 · 2013: 10 · 2012: 2
- FWCI
- 7.17
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Surgery (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Nutrition and Health in Aging
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Oncology › Inflammatory Biomarkers in Disease Prognosis
- Keywords
- hypoalbuminemia, cancer cachexia, pancreatic cancer, TNF-α, interleukin-6, C-reactive protein, inflammatory cytokines, weight loss, phenylalanine
- MeSH terms
- Acute-Phase Proteins, Acute-Phase Reaction, Aged, Albumins, Cachexia, Female, Humans, Male, Middle Aged, Pancreatic Neoplasms, Plasma Volume, Serum Albumin, Cytokines
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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