Hypoalbuminemia 3 months after hospital discharge: significance for long-term survival.
OBJECTIVE
To determine change in albumin from hospital discharge to 3-month follow-up and the prognostic significance of persistent hypoalbuminemia in older veteran patients.


METHODS
A prospective cohort study.


METHODS
A geriatric rehabilitation unit of a university-affiliated Department of Veterans Affairs hospital.


METHODS
The study population consisted of 282 subjects (of 322 randomly selected discharges who were free of cancer and terminal conditions) that completed the 90-day postdischarge assessment; most were older (75.4+/-8.6), white (76%), and male (99%).


METHODS
Each subject completed a comprehensive discharge assessment, had a repeat albumin an average of 94 days later, and was then tracked for 5 years. The strongest predictors of survival were identified using Cox proportional hazards regression analysis.


RESULTS
Between hospital discharge and the 3-month reassessment, albumins improved by more than 2 g/L in 122 subjects (43%), stayed the same in 112 subjects (40%), and deteriorated by more than 2 g/L in the rest. During follow-up, 190 subjects (67%) died. Of the 38 nutritional, functional, demographic, and illness severity variables evaluated, the 3-month postdischarge albumin was the strongest predictor of long-term mortality. Those with albumins less than 35 g/L had a 2.6 times greater mortality than those with albumins of 40 g/L or greater (relative risk=2.6, 95% confidence interval=1.8-3.8). After controlling for 3-month albumin, hospital-discharge albumin was not significantly associated with long-term mortality.


CONCLUSIONS
In older people, a low serum albumin 3 months after hospital discharge is associated with a poor long-term prognosis. It is not known whether this represents ongoing inflammation or inadequate nutrition.
Sullivan
Dennis H
DH
Geriatric Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas 72205, USA. SullivanDennisH@uams.edu
Roberson
Paula K
PK
Bopp
Melinda M
MM
D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D008297:Male; D010351:Patient Discharge; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D013997:Time Factors