Association between Hypoalbuminaemia and Mortality in Patients with Community-Acquired Bacteraemia Is Primarily Related to Acute Disorders.
We sought to investigate whether hypoalbuminaemia was mainly caused by acute or chronic factors in patients with community-acquired bacteraemia. In this population-based study, we considered 1844 adult cases of community-acquired bacteraemia that occurred in Funen, Denmark between 2000 and 2008. We used a stepwise prognostic predisposition-insult-response-organ dysfunction (PIRO) logistic regression model by initially including age and comorbidity, then added bacterial species, and finally sepsis severity. The models were furthermore analysed using receiver operating characteristic (ROC) curves. Outcomes comprised mortality incidence on days 0-30 and 31-365 after the bacteraemia episode. Each step was performed with and without baseline albumin level measured on the date of bacteraemia. In 422 patients, their latest albumin measurement taken 8-30 days before the date of bacteraemia was also used in the analysis together with the baseline albumin level. For each decrease of 1g/L in plasma albumin level, the odds ratios (95% confidence intervals) of mortality in the period of 0-30 days after bacteraemia were 0.86 (0.84-0.88) in both predisposition (P) and predisposition-insult (PI) models and 0.87 (0.85-0.89) in the full PIRO-model. The AUC values were 0.78 and 0.66 for mortality in the period of 0-30 days in the model comprising only predisposition factors with and without albumin levels added as a factor, respectively. The AUC values in the full PIRO-model were 0.81 and 0.73 with and without consideration of albumin levels, respectively. A higher proportion of patients died within 30 days if there was a decrease in the albumin level between days 8 and 30 before bacteraemia and the actual bacteraemia date. A single plasma albumin measurement on the bacteraemia date was a better prognostic predictor of short-term mortality than the sepsis severity score.
Center for Clinical Epidemiology, South, Odense University Hospital, Sdr. Boulevard 29, entrance 101, 4th floor, 5000, Odense C, Denmark.|Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, entrance 101, 4th floor, 5000, Odense C, Denmark.
Bjarne
B
Magnussen
Center for Clinical Epidemiology, South, Odense University Hospital, Sdr. Boulevard 29, entrance 101, 4th floor, 5000, Odense C, Denmark.|Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, entrance 101, 4th floor, 5000, Odense C, Denmark.
Kim
K
Oren Gradel
Department of Clinical Microbiology, Odense University Hospital, J.B. Winsloews Vej 21, 2nd floor, 5000, Odense C, Denmark.
Thøger
T
Gorm Jensen
Department of Clinical Microbiology, Odense University Hospital, J.B. Winsloews Vej 21, 2nd floor, 5000, Odense C, Denmark.
Hans Jørn
HJ
Kolmos
Department of Infectious Diseases, Odense University Hospital, Sdr. Boulevard 29, entrance 20, 5000, Odense C, Denmark.
Court
C
Pedersen
Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Sdr. Boulevard 29, entrance 40, 5000, Odense C, Denmark.
Pernille
P
Just Vinholt
Department of Emergency Medicine, Odense University Hospital, Kløvervænget 25, entrance 63-65, 5000, Odense C, Denmark.
Annmarie
A
Touborg Lassen
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000150:complications* / Q000382:microbiology / Q000401:mortality*; D017714:Community-Acquired Infections / Q000150:complications* / Q000382:microbiology / Q000401:mortality*; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000150:complications*; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012372:ROC Curve; D012042:Registries; D012307:Risk Factors; D018805:Sepsis / Q000150:complications / Q000382:microbiology / Q000401:mortality; D012720:Severity of Illness Index; D055815:Young Adult