title: Severe hypoalbuminemia is a strong independent risk factor for acute respiratory failure in COPD: a nationwide cohort study.
abstract: BACKGROUND
  Acute respiratory failure (ARF) is a life-threatening event, which is frequently associated with the severe exacerbations of chronic obstructive pulmonary disease (COPD). Hypoalbuminemia is associated with increased mortality in patients with COPD. However, to date, little is known regarding whether or not hypoalbuminemia is a risk factor for developing ARF in COPD.
  
  
  METHODS
  We conducted a retrospective cohort study using data from the National Health Insurance system of Taiwan. A total of 42,732 newly diagnosed COPD patients (age ≥40 years) from 1997 to 2011 were enrolled. Among them, 1,861 (4.36%) patients who had received albumin supplementation were defined as hypoalbuminemia, and 40,871 (95.6%) patients who had not received albumin supplementation were defined as no hypoalbuminemia.
  
  
  RESULTS
  Of 42,732 newly diagnosed COPD patients, 5,248 patients (12.3%) developed ARF during the 6 years follow-up period. Patients with hypoalbuminemia were older, predominantly male, had more comorbidities, and required more steroid treatment and blood transfusions than patients without hypoalbuminemia. In a multivariable Cox regression analysis model, being elderly was the strongest independent risk factor for ARF (adjusted hazard ratio [HR]: 4.63, P<0.001), followed by hypoalbuminemia (adjusted HR: 2.87, P<0.001). However, as the annual average dose of albumin supplementation was higher than 13.8 g per year, the risk for ARF was the highest (adjusted HR: 11.13, 95% CI: 10.35-11.98, P<0.001).
  
  
  CONCLUSIONS
  Hypoalbuminemia is a strong risk factor for ARF in patients with COPD. Therefore, further prospective studies are required to verify whether or not albumin supplementation or nutritional support may help to reduce the risk of ARF in patients with COPD.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Chia-Yi Christian Hospital, Chiayi, Taiwan.
authors.forename: Char-Wen
authors.initials: CW
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, Chia-Yi Christian Hospital, Chiayi, Taiwan.
authors.forename: Yih-Yuan
authors.initials: YY
authors.lastname: Chen
authors.affiliation: Department of Medical Research, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chiayi, Taiwan.
authors.forename: Chin-Li
authors.initials: CL
authors.lastname: Lu
authors.affiliation: Department of Medical Research, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chiayi, Taiwan.
authors.forename: Solomon Chih-Cheng
authors.initials: SC
authors.lastname: Chen
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Chia-Yi Christian Hospital, Chiayi, Taiwan ; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi Campus; Changhua, Taiwan.
authors.forename: Yi-Jen
authors.initials: YJ
authors.lastname: Chen
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Chia-Yi Christian Hospital, Chiayi, Taiwan ; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi Campus; Changhua, Taiwan.
authors.forename: Ming-Shian
authors.initials: MS
authors.lastname: Lin
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Chia-Yi Christian Hospital, Chiayi, Taiwan ; College of Nursing, Dayeh University, Changhua, Taiwan ; Department of Respiratory Therapy, China Medical University, Taichung, Taiwan.
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000418:Albumins / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018529:Nutritional Support; D011379:Prognosis; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013624:Taiwan; D013997:Time Factors
chemical_list: D000418:Albumins
keywords: COPD; acute respiratory failure; hypoalbuminemia