DOCSLIB.ORG

Hypoalbuminemia in Critically Ill Children

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Hypoalbuminemia in Critically Ill Children ARTICLE Hypoalbuminemia in Critically Ill Children Ira N. Horowitz, MD; Kenneth Tai, MD Objective: To evaluate whether hypoalbuminemia on Main Outcome Measures: Length of PICU and hos- admission is a predictor of adverse outcome in critically pital stays, receipt and length of ventilatory support, sur- ill children. vival, pediatric risk of mortality score, mortality risk, and number of organ failures. Design: Retrospective medical record review. Results: Controlling for mortality risk, the hypoalbu- Setting: A 14-bed medical and surgical pediatric inten- minemia group had a longer average stay in the PICU sive care unit (PICU). (8.08 vs 4.41 days; 95% confidence interval [CI] for dif- ference,1.02-6.32) and the hospital (11.36 vs 6.63 days; Participants: All patients admitted to the PICU from 95% CI for difference,1.31-8.16) than did the normal al- January 1, 1998, through December 31, 2000, under the bumin level group. The hypoalbuminemia group had a care of the PICU team or trauma service and whose al- lower survival rate (odds ratio,0.10; 95% CI, 0.02-0.46) bumin level was measured were potential subjects. One and a higher number of organ failures (1.38 vs 0.65; 95% hundred fifty-five patients were divided into 4 groups on CI for difference, 0.40-1.04). the basis of age and appropriate albumin level for that age group. The groups of hypoalbuminemic patients were combined (hypoalbuminemia group) and compared with Conclusion: Admission hypoalbuminemia is a signifi- the combined group of patients with albumin levels above cant marker of morbidity and mortality in critically ill the reference cutoff (normal albumin level group). children. Exposure: Serum albumin level. Arch Pediatr Adolesc Med. 2007;161(11):1048-1052 LBUMIN IS THE MOST ABUN- exchange between intravascular and extra- dant protein in blood vascular compartments. plasma, usually constitut- Hypoalbuminemia is associated with ing up to two-thirds of total poor outcomes in adult critical illness, but plasma protein.1 It contrib- whether this association exists in pediat- Autes about 80% of the plasma colloid os- ric patients remains unclear.2-6 There is a motic pressure and is responsible for the paucity of data evaluating serum albu- transport and binding of many molecules. min level on admission as a predictor of Albumin is highly water soluble and re- outcome in critically ill children. Our goal sides in the extracellular space, with one- was to evaluate whether hypoalbumin- third in the intravascular space and two- emia on admission is a marker of adverse thirds in the extravascular space. Typically, outcome in this population. hypoalbuminemia is ascribed to dimin- ished synthesis (eg, malnutrition, malab- METHODS sorption, or hepatic dysfunction) or in- creased losses (eg, urinary losses with nephropathy or protein-losing enteropa- We performed a retrospective medical record thy). Diversion of synthetic capacity to other review of data collected from January 1, 1998, Author Affiliations: proteins (acute-phase reactants) is an- through December 31, 2000, in the pediatric Department of Pediatrics, other cause of hypoalbuminemia. Inflam- intensive care unit (PICU) at the Ronald Loyola University Medical McDonald Children’s Hospital of Loyola Uni- Center, Maywood, Illinois. matory disorders can accelerate the catabo- versity Medical Center. Any pediatric patient Dr Horowitz is now with lism of albumin while simultaneously whose albumin level was measured was a po- Pediatric Critical Care, decreasing its manufacture. During criti- tential subject. Patients were stratified by age Morristown Memorial Hospital, cal illness, capillary permeability in- and serum albumin level on admission. Hypo- Morristown, New Jersey. creases dramatically and alters albumin albuminemia was defined as an albumin level (REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 161 (NO. 11), NOV 2007 WWW.ARCHPEDIATRICS.COM 1048 ©2007 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/24/2021 Table 1. Criteria for Failure of Specific Organ Systemsa Organ System Criteria Cardiovascular MAP, Ͻ 40 mm Hg (infants aged Ͻ 12 mo) MAP, Ͻ 50 mm Hg (children aged Ն 12 mo) HR, Ͻ 50 beats/min (infants aged Ͻ 12 mo) Respiratory HR, Ͻ 40 beats/min (children aged Ն 12 mo) Cardiac arrest Continuous vasoactive drug infusion for hemodynamic support RR, Ͼ 90/min (infants aged Ͼ 12 mo) RR, Ͼ 70/min (children aged Ն 12 mo) PaO2, Ͻ 40 mm Hg (in absence of cyanotic heart disease) PaCO2, Ͻ 65 mm Hg PaO2:FIO2, Ͻ 250 mm Hg Ventilatory support (Ͼ 24 h if postoperative) Tracheal intubation for airway obstruction or acute respiratory failure Neurologic Glasgow coma scale score, Ͻ 5 Fixed, dilated pupils Persistent (Ͼ 20 min) intracranial pressure Ͼ 20 mm Hg or need for therapeutic intervention Hematologic Hemoglobin level, Ͻ 5 g/dL WBC count, Ͻ 3 ϫ103 cells/µL Platelet count, Ͻ 20 000/µL Disseminated intravascular coagulopathy (PT Ͼ 20 s or aPTT Ͼ 60 s in presence of positive FSP assay results) Renal SUN level, Ͼ 100 mg/dL Serum creatinine level, Ͼ 2 mg/dL Need for dialysis Gastrointestinal Blood transfusions, Ͼ 20 mL/kg in 24 h because of gastrointestinal hemorrhage (endoscopic confirmation optional) Hepatic Total bilirubin level, Ͼ 5 mg/dL and SGOT or LDH more than twice the reference value (without evidence of hemolysis) Hepatic encephalopathy Ն grade II10 Abbreviations: aPTT, activated partial thromboplastin time; FIO2, fraction of inspired oxygen; FSP, fibrin split products; HR, heart rate; LDH, lactic dehydrogenase; MAP, mean arterial pressure; PT, prothrombin time; RR, respiratory rate; SGOT, serum glutamic oxaloacetic transminase; SUN, serum urea nitrogen; WBC, white blood cell. SI conversion factors: To convert bilirubin to micromoles per liter, multiply by 17.104; creatinine to micromoles per liter, by 88.4; platelet count to number of cells ϫ109 per liter, multiply by 10; urea nitrogen to millimoles per liter, by 0.357; and WBC count to number of cells ϫ109 per liter, multiply by 0.001. a Reproduced with permission from Wilkinson et al.9 of less than 3.4 g/dL for patients 7 months or older and less experienced significant blood loss during surgery (Ͼ10% of than 2.5 g/dL for patients younger than 7 months.7 (To con- their blood volume), or received blood products or albumin vert albumin to grams per liter, multiply by 10.) All patient data before measurement of the albumin level were also excluded. were combined according to age-specific definitions of hypo- Data recorded included age, sex, diagnosis (categorized by albuminemia. Our institutional review board approved the organ system, eg, respiratory, infectious, neurologic, or car- project and waived the need for consent. diac), pediatric risk of mortality (PRISM) score,8 risk of mor- tality computed from the PRISM score, length of hospital stay, INCLUSION CRITERIA length of PICU stay, receipt and length of ventilatory support, number of organ failures9 (Table 1), outcome (survival), com- All patients admitted to the PICU under the care of the PICU plications, and whether the patient received supplemental al- team or trauma service whose albumin level was measured were bumin. Except for death in an extremely ill child, complica- potential subjects. Arrival to the PICU was required no later than tions were all unexpected, untoward events such as nosocomial the second hospital day, if the patient was initially admitted to pneumonia, decubitus ulcer, or reintubation. the floor. A comprehensive metabolic profile or albumin level was obtained within 48 hours of admission to the hospital. DATA ANALYSIS EXCLUSION CRITERIA Mortality probability was used as a control variable when groups, which were divided according to their albumin level (hypoal- Patients who were not expected to have a normal albumin level buminemic patients [hypoalbuminemia group] vs patients with (ie, a level above the reference cutoff value for their age) in their a normal albumin level [normal albumin level group]) were usual state of health were excluded. Therefore, patients who compared on all outcome variables. Because both the PRISM were malnourished (below the fifth percentile according to and risk of mortality scores were highly skewed, we computed growth curve data) or who had lost weight (Ͼ10% of their body the logarithm of risk of mortality. Analyses of covariance were weight in the premorbid state) were excluded. Other exclu- used to compare the groups on scaled variables (eg, number sion criteria included presence of a chronic disease affecting of organ failures) using the logarithm of mortality risk as a co- the growth and development of the gastrointestinal system (fail- variate. The Mantel-Haenszel test was used to compare the ure to thrive or inflammatory bowel disease) or the kidney (end- groups on categorical variables (eg, survival). In these categori- stage renal disease or proteinuria), receipt of home parenteral cal analyses, mortality risk was controlled with a dichotomy nutrition, or presence of a chromosomal, genetic, or inborn meta- of the logarithm of mortality risk. A median split was used to bolic disorder. Patients who had undergone cardiac surgery, define low and high risk. (REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 161 (NO. 11), NOV 2007 WWW.ARCHPEDIATRICS.COM 1049 ©2007 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/24/2021 Table 2. Diagnostic Groups Patients Aged Ͻ 7mo Patients Aged Ն 7mo Hypoalbuminiaa Normal Albumin Level Hypoalbuminiab Normal Albumin Level Diagnosis by Organ System (n=10) (n=27) (n=41) (n=77) Neurologic 0 6 9 27 Respiratory 1 10 8 13 Infectious disease 5 2 9 3 Cardiovascular 1 3 7 5 Metabolic 1 1 1 10 Toxicology 0 0 1 12 Hematology 0 2 6 3 Gastrointestinal 2 3 0 0 Trauma 0 0 0 2 Renal 0 0 0 1 Rheumatologic 0 0 0 1 a In patients younger than 7 months, hypoalbuminia was defined as an albumin level of less than 2.5 g/dL (to convert to grams per liter, multiply by 10).
Load more

Recommended publications
  • Genetically Determined Hypoalbuminemia As a Risk Factor for Hypertension: Instrumental Variable Analysis Jong Wook Choi1, Joon‑Sung Park2* & Chang Hwa Lee2*
    www.nature.com/scientificreports OPEN Genetically determined hypoalbuminemia as a risk factor for hypertension: instrumental variable analysis Jong Wook Choi1, Joon‑Sung Park2* & Chang Hwa Lee2* Hypoalbuminemia is associated with vascular endothelial dysfunction and the development of chronic cardiovascular diseases. However, the relationship between serum albumin concentration and blood pressure changes remains controversial. Community‑based longitudinal cohort data collected from Korean Genome and Epidemiology Study were used in this study. Hypoalbuminemia was defned as a serum albumin concentration of ≤ 4.0 g/dL. A total of 4325 participants were categorized into control (n = 3157) and hypoalbuminemia (n = 1168) groups. Serum albumin had a non‑linear relationship with the risk of hypertension development. A genome‑wide association study revealed 71 susceptibility loci associated with hypoalbuminemia. Among susceptibility loci, genetic variations at rs2894536 in LOC107986598 and rs10972486 in ATP8B5P were related to elevated blood pressure. Serum albumin (HR = 0.654, 95% CI 0.521–0.820) and polymorphisms of rs2894536 (HR = 1.176, 95% CI 1.015–1.361) and rs10972486 (HR = 1.152, 95% CI 1.009–1.316) were signifcant predictors of hypertension development. Increased albumin concentration instrumented by 2 hypoalbuminemia‑associated SNPs (rs2894536 and rs10972486) was associated with decreased HRs for hypertension development (HR = 0.762, 95% CI 0.659–0.882 and HR = 0.759, 95% CI 0.656–0.878). Our study demonstrated that genetically determined hypoalbuminemia is a signifcant predictor of incipient hypertension. Albumin, one of the major serum proteins, has multiple important physiological functions involving stabilization of plasma colloid osmotic pressure, transportation of diverse substances, and signifcant antioxidant activity, and its concentration is fnely regulated by various systems in the physiologic state 1.
    [Show full text]
  • Glycated Hemoglobin and Glycated Albumin in Patients with Diabetes
    Kitajima et al. Renal Replacement Therapy (2020) 6:10 https://doi.org/10.1186/s41100-020-0260-5 RESEARCH Open Access Glycated hemoglobin and glycated albumin in patients with diabetes undergoing hemodiafiltration Yukie Kitajima1*, Shunichiro Urabe2, Takashi Hosono2, Satoshi Yoshikawa3, Yuzuru Sato3 and Toru Hyodo2 Abstract Background: Online hemodiafiltration (OHDF), which results in high albumin leakage, is now widely used in Japan for dialysis, since the national insurance system began reimbursing its costs in 2012. Glycated albumin (GA) levels are affected by albumin leakage into effluent dialysate fluid. Therefore, GA levels in patients requiring diabetes- related dialysis undergoing OHDF require monitoring. However, there have been no previous reports on glycemic control indicators of patients with diabetes undergoing OHDF. We aimed to develop a glycemic control index for patients requiring diabetes-related dialysis undergoing OHDF. Methods: This study comprised 133 diabetic patients undergoing OHDF. We examined the correlation between GA and glycated hemoglobin (HbA1c) levels. We analyzed effluent dialysate fluid samples from 41 patients classified into 3 groups, namely, group A, non-protein-leaking OHDF (n = 20); group B, protein-leaking OHDF (n = 14); and group C, highly efficient protein-leaking OHDF (n = 7). We examined the association between GA and HbA1c levels in each group and among patients. Results: A significant positive correlation was observed between GA and HbA1c levels (r = 0.562, p < 0.0001). There was no significant correlation between pre-dialysis blood glucose levels and HbA1c or GA levels as observed on regular blood tests performed under non-fasting conditions. Patients were classified into 2 groups based on their mean albumin levels (3.4 g/dL cutoff).
    [Show full text]
  • Clinical and Histopathological Features of Renal Maldevelopment in Boxer Dogs: a Retrospective Case Series (1999–2018) †
    animals Article Clinical and Histopathological Features of Renal Maldevelopment in Boxer Dogs: A Retrospective Case Series (1999–2018) † Maria Alfonsa Cavalera 1, Floriana Gernone 1, Annamaria Uva 1, Paola D’Ippolito 2, Xavier Roura 3 and Andrea Zatelli 1,* 1 Department of Veterinary Medicine, University of Bari, 70010 Valenzano, Italy; [email protected] (M.A.C.); fl[email protected] (F.G.); [email protected] (A.U.) 2 Veterinary diagnostic Lab ACV Triggiano, 70019 Triggiano, Italy; [email protected] 3 Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain; [email protected] * Correspondence: [email protected]; Tel.: +39-080-4679804 † This study was partially presented as oral communication at the 11th ECVIM-CA/ESVIM Congress, Dublin (Ireland) as “Congenital nephrotic syndrome with renal glomerular immaturity in 7 Boxer dogs”. Zatelli, A., Domenech, O., Bussadori, C., Lubas, G., Del Piero, F. Simple Summary: This study describes clinical findings in Boxer dogs with renal maldevelopment and proposes a possible mode of inheritance. Medical records of 9 female Boxer dogs, older than 5 months and with a clinical diagnosis of proteinuric chronic kidney disease prior to one year of age, showed the presence of polyuria and polydipsia, decreased appetite, weight loss, lethargy and weakness in all affected dogs. Common laboratory findings were proteinuria and diluted urine, non- regenerative anemia, azotemia, hyperphosphatemia, hypoalbuminemia and hypercholesterolemia. Citation: Cavalera, M.A.; Gernone, Histopathology of the kidneys identified the presence of immature glomeruli in all dogs. In 7 out F.; Uva, A.; D’Ippolito, P.; Roura, X.; of 9 related dogs, the pedigree analysis showed that a simple autosomal recessive trait may be a Zatelli, A.
    [Show full text]
  • Increasing Ferritin Predicts Early Death in Adult Hemophagocytic Lymphohistiocytosis
    Henry Ford Health System Henry Ford Health System Scholarly Commons Pathology Articles Pathology 2-17-2021 Increasing ferritin predicts early death in adult hemophagocytic lymphohistiocytosis Rand Abou Shaar Charles S. Eby Suzanne van Dorp Theo de Witte Zaher K. Otrock Follow this and additional works at: https://scholarlycommons.henryford.com/pathology_articles Received: 13 November 2020 | Accepted: 29 January 2021 DOI: 10.1111/ijlh.13489 ORIGINAL ARTICLE Increasing ferritin predicts early death in adult hemophagocytic lymphohistiocytosis Rand Abou Shaar1 | Charles S. Eby2 | Suzanne van Dorp3 | Theo de Witte3 | Zaher K. Otrock1 1Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, MI, Abstract USA Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome of 2 Department of Pathology and Immunology, pathologic immune activation. Most studies on adult HLH have evaluated prognostic Washington University School of Medicine, St. Louis, MO, USA factors for overall survival; factors predicting early mortality have not been suffi- 3Radboud University Medical Center, ciently investigated. Nijmegen, Netherlands Methods: This was a collaborative study between Henry Ford Hospital and Barnes- Correspondence Jewish Hospital. We identified all adult HLH patients with at least 2 ferritin levels Zaher K. Otrock, Transfusion Medicine Division, Department of Pathology and within 30 days from admission. Laboratory Medicine, Henry Ford Hospital, Results: One- hundred twenty- four patients were identified. There were
    [Show full text]
  • Hypoalbuminemia at Admission Predicts the Development of Acute Kidney Injury in Hospitalized Patients: a Retrospective Cohort Study
    RESEARCH ARTICLE Hypoalbuminemia at admission predicts the development of acute kidney injury in hospitalized patients: A retrospective cohort study Mi-yeon Yu1, Sung Woo Lee2, Seon Ha Baek3, Ki Young Na4, Dong-Wan Chae4, Ho Jun Chin4, Sejoong Kim4* 1 Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea, 2 Department of a1111111111 Internal Medicine, Eulji General Hospital, Seoul, Korea, 3 Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do, Korea, 4 Department of Internal Medicine, Seoul National a1111111111 University Bundang Hospital, Seongnam, Korea a1111111111 a1111111111 * [email protected] a1111111111 Abstract OPEN ACCESS Citation: Yu M-y, Lee SW, Baek SH, Na KY, Chae D-W, Chin HJ, et al. (2017) Hypoalbuminemia at Background admission predicts the development of acute Development of acute kidney injury (AKI) is common and is associated with poor outcomes. kidney injury in hospitalized patients: A We aimed to determine whether hypoalbuminemia (HA) at admission could be a risk factor retrospective cohort study. PLoS ONE 12(7): e0180750. https://doi.org/10.1371/journal. for the development of AKI and mortality in hospitalized patients. pone.0180750 Editor: Emmanuel A. Burdmann, University of Sao Paulo Medical School, BRAZIL Methods Received: March 14, 2017 We enrolled patients who were admitted to Seoul National University Bundang Hospital Accepted: June 20, 2017 from January 2013 to December 2013. HA at admission was defined as a serum albumin Published: July 19, 2017 level < 3.4 mg/dL measured within two days after admission. AKI was defined as an increase in the serum creatinine level by 0.3 mg/dL or 1.5 times of the baseline value Copyright: © 2017 Yu et al.
    [Show full text]
  • Liver Injury, Hypoalbuminaemia and Severe SARS-Cov-2 Infection
    Letter Liver injury, hypoalbuminaemia and severe SARS- Gut: first published as 10.1136/gutjnl-2021-324570 on 2 June 2021. Downloaded from CoV-2 infection We have read with interest the recent study published in Gut by Weber et al1 outlining liver abnormalities in 217 patients admitted with COVID-19 infec- tion in Germany. Along with respiratory failure, deranged liver blood tests have been demonstrated in many cohort studies of patients admitted with SARS-CoV -2 infection, the clinical relevance of which has been unclear to date.2 3 The authors of this study demonstrated that deranged liver blood tests on admis- sion were associated with more severe morbidity and mortality. Notably, hypoal- buminaemia on admission in this cohort Figure 1 Hypoalbuminemia ROC when incorporated into model. was associated with a severe COVID-19 disease course. older age, male sex, high MULBSTA Naturally, albumin is a negative acute A review of 310 patients admitted with score (a predictive score of viral pneu- phase reactant, and decreased albumin COVID-19 to our institution in Dublin monia mortality4) and body mass index, levels may simply reflect severe systemic revealed abnormal liver blood tests were hypoalbuminaemia predicted death, with inflammation6 7; in our cohort albumin present in almost 50% of patients, in area under the curve receiver operating levels correlated significantly with other particular raised gamma- glutamyl trans- characteristic at 0.8 (figure 1). A notable inflammatory markers such as C reactive ferase (gGT) levels (table 1), similar to elevation in liver blood tests, especially protein (CRP) and white cell count (Spear- 1 that noted by Weber and colleagues.
    [Show full text]
  • Elevated Transaminases and Hypoalbuminemia in Covid-19 Are Prognostic Factors for Disease Severity
    www.nature.com/scientificreports OPEN Elevated transaminases and hypoalbuminemia in Covid‑19 are prognostic factors for disease severity Jason Wagner1, Victor Garcia‑Rodriguez1, Abraham Yu1, Barbara Dutra1, Scott Larson1, Brooks Cash1, Andrew DuPont1 & Ahmad Farooq2,3* Prognostic markers are needed to understand the disease course and severity in patients with Covid‑ 19. There is evidence that Covid‑19 causes gastrointestinal symptoms and abnormalities in liver enzymes. We aimed to determine if hepatobiliary laboratory data could predict disease severity in patients with Covid‑19. In this retrospective, single institution, cohort study that analyzed patients admitted to a community academic hospital with the diagnosis of Covid‑19, we found that elevations of Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT) and Alkaline Phosphatase (AP) at any time during hospital admission increased the odds of ICU admission by 5.12 (95% CI: 1.55–16.89; p = 0.007), 4.71 (95% CI: 1.51–14.69; p = 0.01) and 4.12 (95% CI: 1.21–14.06, p = 0.02), respectively. Hypoalbuminemia found at the time of admission to the hospital was associated with increased mortality (p = 0.02), hypotension (p = 0.03), and need for vasopressors (p = 0.02), intubation (p = 0.01) and hemodialysis (p = 0.002). Additionally, there was evidence of liver injury: AST was signifcantly elevated above baseline in patients admitted to the ICU (54.2 ± 15.70 U/L) relative to those who were not (9.2 ± 4.89 U/L; p = 0.01). Taken together, this study found that hypoalbuminemia and abnormalities in hepatobiliary laboratory data may be prognostic factors for disease severity in patients admitted to the hospital with Covid‑19.
    [Show full text]
  • Could Hypoglycemia and Hypoalbuminemia Allow the Identifcation of Septic Patients at High Mortality Risk in Addition of Clinical Scores?
    Internal and Emergency Medicine (2019) 14:499–501 https://doi.org/10.1007/s11739-019-02081-9 IM - COMMENTARY Could hypoglycemia and hypoalbuminemia allow the identifcation of septic patients at high mortality risk in addition of clinical scores? Marcello Covino1 · Luigi Carbone1 · Benedetta Simeoni1 Received: 15 March 2019 / Accepted: 23 March 2019 / Published online: 29 March 2019 © Società Italiana di Medicina Interna (SIMI) 2019 Sepsis and severe sepsis are an important public health prob- The lack of a “perfect” biomarker of sepsis has led to lems because of elevated mortality (as high as 28.6%) and the production of numerous scoring systems, none of which expensive treatment (about $18,600 USD per hospital stay presents the characteristics of an ideal test. Nevertheless, in the US) [1, 2]. Sepsis incidence and septicemia-related once the sepsis is diagnosed, it is important to start therapy deaths are reported to be growing [3]. Despite the case- as soon as possible, because this is demonstrated to reduce fatality rate has declined due to advances in supportive care mortality [12–14]. for the critically ill patients [4], this trend is expected to The study of Furukawa et al. [15] is a contribution to continue because of aging of the population, increasing of international debate in looking for indicators that can help chronic health conditions, and increased use of immunosup- us to identify in a short time the septic patient at high risk pressive therapy, transplantation, chemotherapy, and inva- of death. The authors have shown that hypoglycemia and sive procedures. hypoalbuminemia are independent factors to identify high- Since 1991, the diagnosis of sepsis has undergone a meta- risk patients in the frst approach in the emergency room.
    [Show full text]
  • Insulin Detemir Use Is Associated with Higher Occurrence Of
    Diabetes Care e1 Insulin Detemir Use Is Associated With Irit Hochberg Higher Occurrence of Hypoglycemia in Hospitalized Patients With Hypoalbuminemia https://doi.org/10.2337/dc17-1957 The insulin analogs detemir and glargine Data were collected for all patients hospitalization, minimal albumin, maximal are the two basal insulins commonly used over 18 years old hospitalized between creatinine, admission length, and ward. in hospitalized patients (1). Their slow- 1 February 2012 and 31 December 2016, Next, a forward and backward stepwise release reservoir is differentdserum treated with detemir or glargine, and with Akaike information criterion regression albumin for detemir and subcutaneous at least one hospitalization albumin blood method was performed; the depen- microcrystals for glargine (2,3). test. The date of lowest albumin level was dent variable was glucose #70 mg/dL. There is a common belief that detemir set as the index event. Exclusion criteria An identical logistic analysis was done should be avoided in hypoalbuminemic were “obstetric ward” (where glargine for glucose #54 mg/dL. Last, a stepwise patients because they have less predict- is not used) and glucose ,15 mg/dL or forward and backward regression method able levels of free insulin, raising a con- albumin ,1 g/dL (owing to the scarcity of with second order interactions was cern for higher risk of hypoglycemia (4,5). such events). The time frame for hypogly- performed. Nevertheless, the guidelines recommend cemia was defined as 5 days around the To further test the “common belief” using either insulin with impartiality index event (2 days before and 2 days after). regarding the effect of detemir on hypo- to hypoalbuminemia (1).
    [Show full text]
  • Anaemia and Serum Protein Alteration in Patients with Pressure Ulcers
    Spinal Cord (1997) 35, 58 ± 60 1997 International Medical Society of Paraplegia All rights reserved 1362 ± 4393/97 $12.00 Anaemia and serum protein alteration in patients with pressure ulcers U Fuoco, G Scivoletto, A Pace, VU Vona and V Castellano IRCCS, Ospedale S. Lucia-Rome, Italy The presence of anaemia and serum protein alteration frequently makes the treatment of pressure ulcers more dicult. Several haemato-chemical parameters were observed in 40 patients with sacral pressure ulcers in order to determine the pathogenesis of these complications. All of the patients showed mild-moderate anaemia with low serum iron and normal or increased ferritin and hypoproteinemia with hypoalbuminemia. Our results suggest that both anaemia and serum protein alteration depend on the chronic in¯ammatory state due to the presence of pressure ulcers. Both anaemia and hypoproteinemia disappeared after pressure ulcer healing. A correct diagnosis is important for the treatment. Iron therapy is useless and potentially dangerous (iatrogenic haemochromatosis) since anaemia is the result of the inability to use iron stores and not iron de®ciency. The treatment of serum protein alterations should be based on a dietary therapy rich in protein and calories; the administration of albumin should be reduced, since albumin is low in essential amino-acids and too expensive; albumin administration should be limited to cases with severe hypoproteinemia and oedema. Keywords: pressure ulcers; anaemia; serum protein alteration; chronic in¯ammatory state Introduction Pressure ulcers are complications which frequently femur. All suered from a sacral pressure ulcer which occur in patients who have been bedridden for a long had persisted for more than 30 days (from 30 days to 6 time.
    [Show full text]
  • Albumin-To-Alkaline Phosphatase Ratio As a Promising Indicator of Prognosis in Human Cancers: Is It Possible? Lin An1, Wei-Tian Yin1 and Da-Wei Sun2*
    An et al. BMC Cancer (2021) 21:247 https://doi.org/10.1186/s12885-021-07921-6 RESEARCH ARTICLE Open Access Albumin-to-alkaline phosphatase ratio as a promising indicator of prognosis in human cancers: is it possible? Lin An1, Wei-tian Yin1 and Da-wei Sun2* Abstract Background: The impact of albumin-to-alkaline phosphatase ratio (AAPR) on prognosis in cancer patients remains uncertain, despite having multiple relevant studies in publication. Methods: We systemically compiled literatures from 3 databases (Cochrane Library, PubMed, and Web of Science) updated to May 24th, 2020. Hazard ratios (HRs) and 95% confidence intervals (CIs) were computed and synthesized using STATA 14, values were then pooled and utilized in order to assess the overall impact of AAPR on patient’s prognosis. Results: In total, 18 studies involving 25 cohorts with 7019 cases were incorporated. Pooled results originated from both univariate and multivariate analyses (HR = 2.14, 95%CI:1.83–2.51, random-effects model; HR = 1.93, 95%CI:1.75– 2.12, fixed-effects model; respectively) suggested that decreased AAPR had adverse effect on overall survival (OS). Similarly, pooled results from both univariate and multivariate analysis of fixed-effects model, evinced that decreased AAPR also had adverse effect on disease-free survival (DFS) (HR = 1.81, 95%CI:1.60–2.04, I2 = 29.5%, P = 0.174; HR = 1.69, 95%CI:1.45–1.97, I2 = 13.0%, P = 0.330; respectively), progression-free survival (PFS) (HR = 1.71, 95%CI: 1.31–2.22, I2 = 0.0%, P = 0.754; HR = 1.90, 95%CI:1.16–3.12, I2 = 0.0%, P = 0.339; respectively), and cancer-specific survival (CSS) (HR = 2.22, 95%CI:1.67–2.95, I2 = 5.6%, P = 0.347; HR = 1.88, 95%CI:1.38–2.57, I2 = 26.4%, P = 0.244; respectively).
    [Show full text]
  • A Case of a 15-Month-Old with Periorbital Edema and Severe Anemia Audrey D
    A Case of a 15-Month-Old With Periorbital Edema and Severe Anemia Audrey D. Kamzan, MD, Charles A. Newcomer, MD, Laura J. Wozniak, MD, MSHS, Noah C. Federman, MD, Lydia S. Kim, MD, MPH This is the case of a previously healthy 15-month-old girl who initially abstract presented to her primary pediatrician with a 2-week history of intermittent periorbital edema. The edema had improved by the time of the visit, and a urine specimen was unable to be obtained in the clinic. A routine fingerstick demonstrated anemia to 8.8 mg/dL, so the patient was started on ferrous sulfate. She then returned to the emergency department 1 month later with severe periorbital edema and pallor but no other significant symptoms. On physical examination, she was tachycardic with striking periorbital edema and an otherwise normal physical examination. She was noted to have a severe microcytic anemia (hemoglobin of 3.9 mg/dL and mean corpuscular Mattel Children’s Hospital and University of California, Los Angeles, Los Angeles, California volume of 53.1 fL) and hypoalbuminemia (albumin of 1.9 g/dL and total protein of 3.3 g/dL). The remainder of her electrolytes and liver function test Drs Kamzan, Newcomer, and Kim conceptualized this diagnostic dilemma and drafted the initial results were within normal limits. A urinalysis was sent, which was negative manuscript; Drs Wozniak and Federman contributed for protein. Our panel of experts reviews her case to determine a unifying to drafting the initial manuscript; and all authors diagnosis for both her severe anemia and her hypoalbuminemia.
    [Show full text]