Prealbumin measurement as a screening tool for protein calorie malnutrition in emergency hospital admissions: a pilot study.
OBJECTIVE
To examine the effectiveness of prealbumin measurement as a routine diagnostic test for protein calorie malnutrition (PCM) in emergency admissions.


METHODS
Cohort study.


METHODS
Canadian tertiary care hospital.


METHODS
A total of 147 consecutive patients admitted through the emergency department, excluding psychiatric admissions, for whom a serum sample was sent to the chemistry laboratory.


METHODS
(1) Albumin and prealbumin levels to diagnose PCM; (2) length of stay (LOS), in-hospital mortality, and nutritional supplementation in patients with PCM; and (3) cost analysis of using prealbumin level as an admission screening test for PCM.


RESULTS
Twenty-four per cent of the patients had at least mild PCM (prealbumin level < 160 mg/L). Albumin level (< 35 g/L) had a sensitivity of 50% and specificity of 95% in identifying PCM. The mean LOS in the patients with PCM was 16 (standard deviation 18) days, compared with 8 (SD 12) days in the patients without PCM (p < 0.0002). The in-hospital mortality rate was 17% in patients with PCM compared with 4% in patients without PCM (p < 0.02). Only 42% of patients with PCM received nutritional supplementation. Cost analysis of screening with prealbumin level projected a saving of $414 per patient screened.


CONCLUSIONS
PCM is underdiagnosed in current clinical practice and is associated with an increased LOS and mortality rate. Prealbumin is a biochemical marker that could be used as a cost-effective screening test to identify patients with PCM who may benefit from nutritional supplementation.
Potter
M A
MA
Department of Medical Biochemistry, McMaster University, Hamilton, Ont. mpotter@FHS.mcmaster.ca
Luxton
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D004632:Emergency Medical Services; D002149:Energy Intake; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D018529:Nutritional Support / Q000191:economics; D010865:Pilot Projects; D011228:Prealbumin / Q000032:analysis*; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D012709:Serum Albumin / Q000032:analysis*
D015415:Biomarkers; D011228:Prealbumin; D012709:Serum Albumin