title: Hypoalbuminemia and lymphocytopenia in patients with decompensated biventricular failure.
abstract: BACKGROUND
  In patients hospitalized with decompensated biventricular failure having hypoalbuminemia and lymphocytopenia without underlying hepatic or renal disease, we addressed the presence of a protein-losing enteropathy (PLE).
  
  
  METHODS
  We studied 78 patients having a dilated cardiomyopathy, who were hospitalized with congestive heart failure (CHF) and hypoalbuminemia of uncertain origin. In the first 19 patients, we investigated the presence of PLE using Tc-Dex scintigraphy together with serum albumin 2 to 4 weeks later when compensation had been restored. In the next 59 patients, presenting with reduced serum albumin and relative lymphocyte count at admission, these parameters were again monitored (2-4 weeks) later when symptoms and signs of CHF had resolved.
  
  
  RESULTS
  PLE, documented by Tc-Dex(70) scintigraphy, was found in 10 of 19 patients and whose hypoalbuminemia (2.7 +/- 0.1 g/dL, mean +/- standard error of mean) were corrected (3.3 +/- 0.1 g/dL; P < 0.05) with the resolution of CHF, whereas in the 9 patients without a PLE, reduced baseline serum albumin (2.6 +/- 0.1 g/dL) failed to improve on follow-up (2.6 +/- 0.2 g/dL) in keeping with malnutrition. Relative lymphocyte count was reduced (14.6 +/- 1.5%) in patients with PLE but was normal (21.4 +/- 3.3%; P < 0.05) in those without PLE. Serum albumin and relative lymphocyte count were each reduced at admission (2.8 +/- 0.1 g/dL and 14.4 +/- 1.0%, respectively) in 59 patients and increased (P < 0.05) to normal values (3.5 +/- 0.1 g/dL and 24.9 +/- 1.0%) 2 to 4 weeks after they were compensated.
  
  
  CONCLUSIONS
  Enteral losses of albumin and lymphocytes account for the reversible hypoalbuminemia and lymphocytopenia found in patients hospitalized with CHF having splanchnic congestion.
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Battin
authors.forename: Sheharyar
authors.initials: S
authors.lastname: Ali
authors.forename: Atta U
authors.initials: AU
authors.lastname: Shahbaz
authors.forename: J Daniel
authors.initials: JD
authors.lastname: Massie
authors.forename: Ahmad
authors.initials: A
authors.lastname: Munir
authors.forename: Richard C
authors.initials: RC
authors.lastname: Davis
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Newman
authors.forename: Karl T
authors.initials: KT
authors.lastname: Weber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D034141:Hypoalbuminemia / Q000150:complications / Q000000981:diagnostic imaging*; D008231:Lymphopenia / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011504:Protein-Losing Enteropathies / Q000150:complications / Q000000981:diagnostic imaging; D011877:Radionuclide Imaging