title: Impact of prealbumin levels on mortality in patients with acute kidney injury: an observational cohort study.
abstract: OBJECTIVE
  We evaluated the prognostic value of prealbumin (transthyretin) levels in patients with acute kidney injury (AKI).
  
  
  METHODS
  This was a longitudinal, single-center, observational cohort study.
  
  
  METHODS
  The setting was a university-affiliated hospital.
  
  
  METHODS
  One hundred and sixty-one consecutive patients with AKI matched at least one of the Risk, Injury, Failure, Loss, End Stage (RIFLE) criteria for increased serum creatinine, and had requested a nephrology consultation between April 2000 and March 2006.
  
  
  METHODS
  We conducted a computer-assisted review of all cases of AKI seen by a nephrologist between April 2000 and March 2006. We used Cox proportional hazards models to estimate the risk of in-hospital mortality associated with serum prealbumin level at the beginning of the nephrology consultation.
  
  
  RESULTS
  Clinicopathologic variables were compared between patients with a serum prealbumin level <11 mg/dL (the exposed group; cutoff point, median) and patients with a serum prealbumin level > or =11 mg/dL (the control group). In-hospital mortality rates associated with prealbumin levels were 45.0% for <11 mg/dL, and 19.8% for > or =11 mg/dL (P = .001). After adjusted analysis, the presence of a serum prealbumin level <11 mg/dL was significantly associated with increased in-hospital mortality (hazard ratio, 2.10; 95% confidence interval, 1.08 to 4.08), compared with patients with the same Liano scoring, the same RIFLE classes, and the same treatment for AKI, but with a serum prealbumin level > or =11 mg/dL. In addition, each increment of 5 mg/dL of serum prealbumin was associated with an adjusted 29% decrease of in-hospital mortality (hazard ratio, 0.71; 95% confidence interval, 0.52 to 0.96).
  
  
  CONCLUSIONS
  Serum prealbumin levels <11 mg/dL were strongly associated with a higher risk of death, independent of AKI severity, comorbid illnesses, serum C-reactive protein levels, and other possible confounders. The measurement of serum prealbumin levels may be an inexpensive and useful tool in the evaluation of the risk profiles of AKI patients.
authors.affiliation: Department of Anesthesia and Critical Care, Clinica Universitaria, University of Navarra, Pamplona, Spain. jrpvaldi@unav.es
authors.forename: Jose Ramon
authors.initials: JR
authors.lastname: Perez Valdivieso
authors.forename: Maira
authors.initials: M
authors.lastname: Bes-Rastrollo
authors.forename: Pablo
authors.initials: P
authors.lastname: Monedero
authors.forename: Jokin
authors.initials: J
authors.lastname: de Irala
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Lavilla
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011228:Prealbumin / Q000032:analysis*; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D011228:Prealbumin; D002097:C-Reactive Protein