title: Serum prealbumin and its changes over time are associated with mortality in acute kidney injury.
abstract: Serum prealbumin is a clinically relevant indicator of nutritional status and inflammation in patients with acute kidney injury (AKI). This study aimed to determine whether serum prealbumin and its longitudinal changes over a week could improve the prediction of 90-day mortality in AKI patients. This prospective cohort study included 340 adults with AKI between 2014 and 2015. There were 94 (27.6%) patient deaths within 90 days. Serum prealbumin level <10 mg/dL at the time of AKI diagnosis was associated with a 155% increased death risk ratio (adjusted hazard ratio [HR], 2.55; 95% confidence interval [CI], 1.18 to 5.49; P = 0.02). Serum prealbumin fall >4 mg/dL was also associated with 90-day mortality in adjusted Cox regression models (HR, 1.79; 95% CI, 1.06 to 3.03; P = 0.03). Compared to serum albumin, mortality-predictability of serum prealbumin (P = 0.01) and its changes (P = 0.01) were both increased. Adding prealbumin and its changes on the conventional covariates improved the prediction of progression to 90-day mortality (NRI 0.29, P = 0.04; aIDI 0.08; P = 0.03). In conclusion, serum prealbumin, and its changes were independent predictors of worse prognosis in AKI, and could be potential surrogates to better predict 90-day mortality.
authors.affiliation: Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200011, China.
authors.forename: Wenji
authors.initials: W
authors.lastname: Wang
authors.affiliation: Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200011, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Pan
authors.affiliation: Institute of Vascular surgery, Division of Vascular surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Tang
authors.affiliation: Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200011, China.
authors.forename: Guihua
authors.initials: G
authors.lastname: Hao
authors.affiliation: Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200011, China.
authors.forename: Yingxin
authors.initials: Y
authors.lastname: Xie
authors.affiliation: Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200011, China.
authors.forename: Shuai
authors.initials: S
authors.lastname: Ma
authors.affiliation: Department of Biostatistics, Public Health School, Fudan University, Shanghai 200032, China.
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Luo
authors.affiliation: Institute of Vascular surgery, Division of Vascular surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Daqiao
authors.initials: D
authors.lastname: Guo
authors.affiliation: Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200011, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Ding
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000401:mortality*; D000368:Aged; D016001:Confidence Intervals; D003710:Demography; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011228:Prealbumin / Q000378:metabolism*; D011336:Probability; D012372:ROC Curve; D013997:Time Factors
chemical_list: D011228:Prealbumin