title: Low prealbumin is a significant predictor of medical complications in severe anorexia nervosa.
abstract: OBJECTIVE
  Prealbumin levels have been proven to correlate with hospital length of stay, wound healing, infection rates, and mortality in adults hospitalized for medical or surgical purposes, or those who have chronic illnesses. Little is known about the utility of prealbumin evaluation in adults with severe anorexia nervosa (AN).
  
  
  METHODS
  We retrospectively evaluated prealbumin levels, along with numerous other clinical parameters relevant to illness acuity and early refeeding outcomes, in 132 adults with AN admitted for definitive inpatient medical stabilization from October 1, 2008 to December 31, 2012. Per clinical protocol, prealbumin was checked on admission and approximately weekly thereafter until discharge.
  
  
  RESULTS
  Patients had a median age of 28 years old, a mean admission body mass index (BMI) of 12.9 kg/m(2) (S.D. 6.1), and 89% of patients were women. A total of 47% of patients had a low prealbumin at the time of admission. By discharge, 77% of patients had normalized their prealbumin levels. Patients with low admission prealbumin levels had a threefold increased risk of refeeding hypophosphatemia and a twofold increase in hypoglycemia compared with patients who had a normal admission prealbumin, independent of admission BMI.
  
  
  CONCLUSIONS
  A low serum prealbumin level appeared concurrent with other markers of serious medical compromise, and was associated with two potentially life threatening complications of early refeeding: hypophosphatemia and hypoglycemia. The cause of low prealbumin remains elusive. Prealbumin should be checked in patients with severe AN prior to initiating weight restoration, as low levels may be an important harbinger of early refeeding complications.
authors.affiliation: Department of Medicine, University of Colorado Denver, Denver, Colorado; ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Gaudiani
authors.forename: Allison L
authors.initials: AL
authors.lastname: Sabel
authors.forename: Philip S
authors.initials: PS
authors.lastname: Mehler
mesh_terms: D000328:Adult; D000368:Aged; D000856:Anorexia Nervosa / Q000097:blood* / Q000150:complications; D015415:Biomarkers / Q000097:blood; D001823:Body Composition; D015992:Body Mass Index; D005260:Female; D006760:Hospitalization; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology; D017674:Hypophosphatemia / Q000209:etiology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011228:Prealbumin / Q000032:analysis*; D055677:Refeeding Syndrome / Q000097:blood / Q000150:complications*; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D011228:Prealbumin
keywords: albumin; anorexia nervosa; biomarkers; critical; hypophosphatemia; medical complications; nutritional status; prealbumin; refeeding syndrome; severely low BMI