Changes in serum albumin concentrations over 7 days in medical inpatients with and without nutritional support. A secondary post-hoc analysis of a randomized clinical trial.
Journal
European journal of clinical nutrition
ISSN: 1476-5640
Titre abrégé: Eur J Clin Nutr
Pays: England
ID NLM: 8804070
Informations de publication
Date de publication:
10 2023
10 2023
Historique:
received:
19
01
2023
accepted:
19
06
2023
revised:
14
06
2023
medline:
12
10
2023
pubmed:
8
7
2023
entrez:
7
7
2023
Statut:
ppublish
Résumé
Serum albumin concentrations are frequently used to monitor nutritional therapy in the hospital setting but supporting studies are largely lacking. Within this secondary analysis of a randomized nutritional trial (EFFORT), we assessed whether nutritional support affects short-term changes in serum albumin concentrations and whether an increase in albumin concentration has prognostic implications regarding clinical outcome and response to treatment. We analyzed patients with available serum albumin concentrations at baseline and day 7 included in EFFORT, a Swiss-wide multicenter randomized clinical trial that compared individualized nutritional therapy with usual hospital food (control group). Albumin concentrations increased in 320 of 763 (41.9%) included patients (mean age 73.3 years (SD ± 12.9), 53.6% males) with no difference between patients receiving nutritional support and controls. Compared with patients that showed a decrease in albumin concentrations over 7 days, those with an increase had a lower 180-day mortality [74/320 (23.1%) vs. 158/443 (35.7%); adjusted odds ratio 0.63, 95% CI 0.44 to 0.90; p = 0.012] and a shorter length of hospital stay [11.2 ± 7.3 vs. 8.8 ± 5.6 days, adjusted difference -2.2 days (95%CI -3.1 to -1.2)]. Patients with and without a decrease over 7 days had a similar response to nutritional support. Results from this secondary analysis indicate that nutritional support did not increase short-term concentrations of albumin over 7 days, and changes in albumin did not correlate with response to nutritional interventions. However, an increase in albumin concentrations possibly mirroring resolution of inflammation was associated with better clinical outcomes. Repeated in-hospital albumin measurements in the short-term is, thus, not indicated for monitoring of patients receiving nutritional support but provides prognostic information. ClinicalTrials.gov Identifier: NCT02517476.
Sections du résumé
BACKGROUND
Serum albumin concentrations are frequently used to monitor nutritional therapy in the hospital setting but supporting studies are largely lacking. Within this secondary analysis of a randomized nutritional trial (EFFORT), we assessed whether nutritional support affects short-term changes in serum albumin concentrations and whether an increase in albumin concentration has prognostic implications regarding clinical outcome and response to treatment.
METHODS
We analyzed patients with available serum albumin concentrations at baseline and day 7 included in EFFORT, a Swiss-wide multicenter randomized clinical trial that compared individualized nutritional therapy with usual hospital food (control group).
RESULTS
Albumin concentrations increased in 320 of 763 (41.9%) included patients (mean age 73.3 years (SD ± 12.9), 53.6% males) with no difference between patients receiving nutritional support and controls. Compared with patients that showed a decrease in albumin concentrations over 7 days, those with an increase had a lower 180-day mortality [74/320 (23.1%) vs. 158/443 (35.7%); adjusted odds ratio 0.63, 95% CI 0.44 to 0.90; p = 0.012] and a shorter length of hospital stay [11.2 ± 7.3 vs. 8.8 ± 5.6 days, adjusted difference -2.2 days (95%CI -3.1 to -1.2)]. Patients with and without a decrease over 7 days had a similar response to nutritional support.
CONCLUSION
Results from this secondary analysis indicate that nutritional support did not increase short-term concentrations of albumin over 7 days, and changes in albumin did not correlate with response to nutritional interventions. However, an increase in albumin concentrations possibly mirroring resolution of inflammation was associated with better clinical outcomes. Repeated in-hospital albumin measurements in the short-term is, thus, not indicated for monitoring of patients receiving nutritional support but provides prognostic information.
TRAIL REGISTRATION
ClinicalTrials.gov Identifier: NCT02517476.
Identifiants
pubmed: 37419969
doi: 10.1038/s41430-023-01303-w
pii: 10.1038/s41430-023-01303-w
pmc: PMC10564620
doi:
Substances chimiques
Serum Albumin
0
Banques de données
ClinicalTrials.gov
['NCT02517476']
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
989-997Informations de copyright
© 2023. The Author(s).
Références
Md State Med J. 1965 Feb;14:61-5
pubmed: 14258950
Clin Sci (Lond). 2001 Aug;101(2):173-9
pubmed: 11473492
N Engl J Med. 1999 Feb 11;340(6):448-54
pubmed: 9971870
JPEN J Parenter Enteral Nutr. 2014 Feb;38(2):186-95
pubmed: 24247093
Lancet. 1985 Apr 6;1(8432):781-4
pubmed: 2858667
J Am Diet Assoc. 1989 May;89(5):684-7
pubmed: 2498417
Expert Opin Drug Deliv. 2015 May;12(5):793-812
pubmed: 25518870
Nutr Clin Pract. 2021 Feb;36(1):22-28
pubmed: 33125793
JPEN J Parenter Enteral Nutr. 1977;1(1):11-22
pubmed: 98649
J Clin Med. 2019 May 31;8(6):
pubmed: 31159248
Surgery. 1988 Aug;104(2):199-207
pubmed: 2456626
J Clin Med. 2019 Jul 20;8(7):
pubmed: 31330781
Clin Nutr. 2022 Jun;41(6):1307-1315
pubmed: 35552050
JAMA Netw Open. 2020 Mar 2;3(3):e200663
pubmed: 32154887
Clin Nutr. 2021 Jul;40(7):4745-4761
pubmed: 34242915
Clin Nutr. 1999 Aug;18(4):197-201
pubmed: 10578018
JPEN J Parenter Enteral Nutr. 2012 Mar;36(2):197-204
pubmed: 21799187
J Am Diet Assoc. 2004 Aug;104(8):1258-64
pubmed: 15281044
Nutrition. 2015 Nov-Dec;31(11-12):1385-93
pubmed: 26429660
JPEN J Parenter Enteral Nutr. 2023 Mar;47(3):408-419
pubmed: 36587281
J Surg Oncol. 1985 Jul;29(3):160-5
pubmed: 3935870
JAMA Netw Open. 2019 Nov 1;2(11):e1915138
pubmed: 31747030
Am J Clin Nutr. 2021 Aug 2;114(2):731-740
pubmed: 33829236
Clin Nutr. 2003 Aug;22(4):415-21
pubmed: 12880610
Clin Nutr. 2003 Jun;22(3):321-36
pubmed: 12765673
Lancet. 2021 Nov 20;398(10314):1927-1938
pubmed: 34656286
Clin Chem. 2006 Dec;52(12):2177-9
pubmed: 17138848
JPEN J Parenter Enteral Nutr. 2003 Jan-Feb;27(1):1-9
pubmed: 12549591
Clin Nutr. 2020 Sep;39(9):2720-2729
pubmed: 31882232
Clin Nutr. 2021 May;40(5):2762-2771
pubmed: 33933742
EClinicalMedicine. 2022 Feb 11;45:101301
pubmed: 35198927
Lancet. 2019 Jun 8;393(10188):2312-2321
pubmed: 31030981
Am J Med. 2020 Jun;133(6):713-722.e7
pubmed: 31751531
Clin Nutr ESPEN. 2021 Oct;45:45-54
pubmed: 34620354
Clin Nutr. 2021 Apr;40(4):1546-1554
pubmed: 33743290
Nutr Clin Pract. 2019 Feb;34(1):96-111
pubmed: 30468264