title: Clinical characteristics and prognostic significance of serum albumin changes in an internal medicine ward.
abstract: BACKGROUND
  The prognostic significance of hypoalbuminemia and the dynamic changes in serum albumin during hospitalization in internal medicine wards has not been sufficiently investigated.
  
  
  METHODS
  Demographic, clinical and laboratory data were collected from 276 patients admitted to our internal medicine ward for a variety of acute disorders. Following discharge, all-cause mortality was recorded. These data were compared between patient groups, according to levels of albumin: hypoalbuminemia or normoalbuminemia (serum albumin <34 g/l and ≥ 34 g/l, respectively), on admission and discharge.
  
  
  RESULTS
  Hypoalbuminemia on admission and on discharge was found in 46% and 54% of patients, respectively. Anemia, renal dysfunction, malignant disease, hypocholesterolemia, lymphopenia and albuminuria were more prevalent in patients with hypoalbuminemia, compared to those with normoalbuminemia (p ≤ 0.03). During a median follow-up period of 23 months, 107 of 276 patients died. Mortality was significantly higher (p<0.001) in patients with hypoalbuminemia than normoalbuminemia on admission (52.0% vs. 27.5%) and on discharge (53.7% vs. 21.2%), including those admitted with normoalbuminemia and discharged with hypoalbuminemia (43.6%). Survival rate was higher for patients admitted with hypoalbuminemia and discharged with normoalbuminemia than for those remaining with hypoalbuminemia (82.4% vs. 42.8%, p=0.004). The level of albumin on discharge (each 10 g/l decrement) was the most powerful predictor of shortened survival (relative risk 2.79, 95% confidence interval 2.04-3.70).
  
  
  CONCLUSIONS
  Hypoalbuminemia on admission, as well as persistence or development of hypoalbuminemia throughout hospitalization, was associated with poor prognosis. Treatment aimed at increasing low albumin or maintaining its normal level may improve survival.
authors.affiliation: Department of Internal Medicine "F", Assaf Harofeh Medical Center (affiliated to Sackler School of Medicine, Tel Aviv University), Zerifin, Israel.
authors.forename: Dana
authors.initials: D
authors.lastname: Barchel
authors.forename: Dorit
authors.initials: D
authors.lastname: Almoznino-Sarafian
authors.forename: Miriam
authors.initials: M
authors.lastname: Shteinshnaider
authors.forename: Irma
authors.initials: I
authors.lastname: Tzur
authors.forename: Natan
authors.initials: N
authors.lastname: Cohen
authors.forename: Oleg
authors.initials: O
authors.lastname: Gorelik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications / Q000401:mortality*; D005260:Female; D006757:Hospital Units; D006760:Hospitalization; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood / Q000150:complications / Q000401:mortality*; D007239:Infections / Q000097:blood / Q000150:complications / Q000401:mortality*; D007388:Internal Medicine; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000150:complications / Q000401:mortality*; D010351:Patient Discharge; D011379:Prognosis; D012709:Serum Albumin
chemical_list: D012709:Serum Albumin
keywords: Albumin; Hospitalization; Mortality; Prognosis