What is the relationship between serum albumin concentration and malnutrition?

Decreased albumin in adults is a marker of associated disease (a negative acute phase reactant) not a feature of isolated protein-energy malnutrition.

Serum albumin does not decrease significantly in starvation, although production is affected. The body maintains the serum albumin at the expense of muscular protein: There is decreased synthesis, increased redistribution & decreased catabolism. Moreover, albumin has a long half life, compared with pre-albumin. As a result, when the patient's nutritional status is improving, the pre-albumin will tend to bounce back earlier. If critical illness persists, catabolism persists, and the levels of both of these markers will remain low. In general it is unwise to rely on these as markers of nutrition in critical care.

Is there any relationship between hypoalbuminemia and outcome?

Low serum albumin is an independent indicator of (poor) outcome in critical illness.

There is a considerable body of evidence indicating that serum albumin is a prognostic indicator. Goldwasser (1997) suggests that albumin may well be an independent indicator of outcome in a variety of clinical settings. The lower the serum albumin plunges, the greater the mortality, morbidity, length of stay and complication rate. Blunt (1998) and colleagues have shown that non-survivors in intensive care had lower mean albumin concentrations than survivors, and there was, significantly, no difference between the COPs of the two groups.




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