Epidemiology of Hypoalbuminemia in Hospitalized Patients: A Clinical Matter or an Emerging Public Health Problem?
Abstract
:1. Introduction
2. Materials and Methods
Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Variable | Frequency, N. (%) | Albumin Level, Mean (mg/dL) ± SD | p Values (ANOVA Test) | |
---|---|---|---|---|
Gender | Males | 5238 (55.6) | 3.392 ± 0.683 | NS |
Females | 4190 (44.4) | 3.378 ± 0.614 | ||
AGE (years) | <40 | 886 (9.4) | 3.734 ± 0.604 | All statistically significant p < 0.001 except 40–50 vs. 50–60 NS |
40-50 | 879 (9.3) | 3.558 ± 0.635 | ||
50-60 | 1502 (15.9) | 3.481 ± 0.641 | ||
60-70 | 2067 (21.9) | 3.393 ± 0.629 | ||
70-80 | 2340 (24.8) | 3.306 ± 0.584 | ||
>80 | 1754 (18.6) | 3.143 ± 0.568 | ||
CITIZENSHIP | Italian | 8674 (92) | 3.376 ± 0.630 | |
Foreign | 754 (8) | 3.501 ± 0.652 | <0.001 | |
MARITAL STATUS | Single | 1638 (17.4) | 3.494 ± 0.650 | Single vs. Married |
Married | 7245 (76.8) | 3.360 ± 0.628 | <0.001 | |
Separated/Divorced | 218 (2.3) | 3.420 ± 0.638 | ||
Widow | 327 (3.5) | 3.382 ± 0.597 | Single vs. Widow = 0.035 | |
EDUCATION | Illiterate | 83 (0.9) | 3.385 ± 0.593 | Prim. vs. Int. <0.001 |
Primary School | 1242 (13.2) | 3.270 ± 0.592 | Prim. vs. Sec. <0.001 | |
Intermediate School | 6211 (65.9) | 3.357 ± 0.626 | Prim. vs. High <0.001 | |
Secondary School | 1570 (16.7) | 3.551 ± 0.654 | Int. vs. Sec. <0.001 | |
Higher Education | 322 (3.4) | 3.578 ± 0.630 | Int. vs. High = 0.044 |
Albuminemia at Baseline | Frequency n, (%) | Value, Mean Value ± SD | Prevalence in >65 Years Old, n, (%) | Prevalence in <65 Years Old, n, (%) |
---|---|---|---|---|
Marked hypoalbuminemia (<2.5 mg/dL), and | 909 (9.6) | 2.177 ± 0.288 | 613 (67.4) | 296 (32.6) |
p < 0.001 | ||||
Mild hypoalbuminemia (2.5–3.5 mg/dL) | 4045 (42.9) | 3.073 ± 0.267 | 2714 (67.1) | 1331 (32.9) |
p < 0.001 | ||||
Normal albuminemia (3.5–4.5 mg/dL) | 4199 (44.5) | 3.884 ± 0.259 | 2009 (47.8) | 2190 (52.2) |
p < 0.001 | ||||
Hyperalbuminemia (>4.5 mg/dL) | 214 (2.3) | 4.645 ± 0.127 | 46 (21.5) | 168 (78.5) |
p < 0.001 |
Major Diagnostic Categories (MDC24) | Frequency | Percentage | Albumin at Baseline (mg/dL), Mean ± SD |
---|---|---|---|
diseases and disorders of the nervous system (1) | 1830 | 19.8 | 3.663 ± 0.481 |
diseases and disorders of the respiratory system (4) | 1299 | 14.1 | 3.254 ± 0.621 |
diseases and disorders of the circulatory system (5) | 1194 | 12.9 | 3.134 ± 0.621 |
diseases and disorders of the musculoskeletal system and connective tissue (8) | 1128 | 12.2 | 3.471 ± 0.535 |
diseases and disorders of the digestive system (6) | 945 | 10.2 | 3.324 ± 0.667 |
diseases and disorders of the hepatobiliary system and pancreas (7) | 831 | 9.0 | 3.291 ± 0.651 |
myeloproliferative DDs (poorly differentiated neoplasms) (17) | 429 | 4.6 | 3.485 ± 0.616 |
diseases and disorders of the kidney and urinary tract (11) | 404 | 4.4 | 3.297 ± 0.692 |
infectious and parasitic DDs (Systemic or unspecified sites) (18) | 178 | 1.9 | 2.861 ± 0.591 |
factors influencing health status and other contacts with health services (23) | 177 | 1.9 | 3.578 ± 0.674 |
diseases and disorders of the endocrine, nutritional and metabolic system (10) | 169 | 1.8 | 3.472 ± 0.578 |
diseases and disorders of the blood and blood forming organs and immunological disorders (16) | 144 | 1.6 | 3.372 ± 0.646 |
diseases and disorders of the skin, subcutaneous tissue and breast (9) | 102 | 1.1 | 3.328 ± 0.645 |
diseases and disorders of the ear, nose, mouth and throat (3) | 96 | 1.0 | 3.897 ± 0.56 |
mental diseases and disorders (19) | 95 | 1.0 | 3.552 ± 0.531 |
injuries, poison and toxic effect of drugs (21) | 70 | 0.8 | 3.014 ± 0.761 |
diseases and disorders of the eye (2) | 51 | 0.6 | 3.991 ± 0.402 |
multiple significant trauma (24) | 46 | 0.5 | 3.027 ± 0.689 |
human Immunodeficiency virus infection (25) | 21 | 0.2 | 3.235 ±0.845 |
diseases and disorders of the male reproductive system (12) | 13 | 0.1 | 3.243 ± 0.669 |
diseases and disorders of the female reproductive system (13) | 13 | 0.1 | 3.328 ± 0.507 |
alcohol/drug use or induced mental disorders (20) | 6 | 0.1 | 3.418 ± 0.623 |
newborn and other neonates (perinatal period) (15) | 3 | 0 | 3.483 ± 0.317 |
burns (22) | 1 | 0 | 3.030 |
Total | 9245 | 100 | 3.385 ± 0.629 |
MDC24 | Diagnosis of Hospitalization (DRG24) | Frequencies | Percentages | Albumin at Baseline (Mg/Dl), Mean ± SD | Significant Differences among Drgs: p Values <0.05 (ANOVA Test) |
---|---|---|---|---|---|
1 | Transient cerebral ischemia (524) | 101 | 1.1 | 3.670 ± 0.442 | vs. 87, 89, 104, 127, 179, 202, 210, 544, 569 |
17 | Acute leukemia without major surgery (473) | 101 | 1.1 | 3.570 ± 0.547 | vs. 87, 89, 104, 127, 179, 202, 210, 569 |
6 | Inflammatory diseases of intestine (179) | 102 | 1.1 | 3.300 ± 0.584 | vs. 2, 12, 14, 75, 104, 219, 467, 473, 543 |
6 | Major surgery of both large and small intestine (569) | 104 | 1.1 | 3.285 ± 0.826 | vs. 2, 12, 14, 75, 219, 410, 467, 473, 524, 543, 544 |
23 | Other factors affecting the state of health (467) | 110 | 1.2 | 3.900 ± 0.624 | vs. 87, 89, 104, 127, 179, 202, 210, 410, 544, 569 |
8 | Operation on the lower limb and humerus except hip. foot and femur (219) | 124 | 1.3 | 3.600 ± 0.418 | vs. 87, 89, 104, 127, 179, 202, 210, 544, 569 |
17 | Chemotherapy not associated with secondary diagnosis of acute leukemia (410) | 127 | 1.3 | 3.440 ±0.545 | vs. 2, 12, 75, 87, 89, 104, 202, 210, 467, 569 |
1 | Degenerative diseases of the nervous system (12) | 136 | 1.4 | 3.830 ± 0.436 | vs. 87, 89, 104, 127, 179, 202, 210, 410, 544, 569 |
1 | Craniotomy with major device implant or major diagnosis of complex acute pathology of the central nervous system (543) | 143 | 1.5 | 3.570 ± 0.426 | vs. 87, 89, 104, 127, 179, 202, 210, 569 |
8 | Hip and femur surgery. except major joints (210) | 147 | 1.6 | 3.090 ± 0.420 | vs. 2, 12, 14, 75, 219, 410, 467, 473, 524, 543, 544 |
5 | Heart valve surgery and other major cardiothoracic surgeries with cardiac catheterization (104) | 155 | 1.6 | 2.800 ± 0.562 | vs. 2, 12, 14, 75, 87, 127, 179, 202, 410, 467, 473, 524, 543, 544 |
1 | Craniotomy (2) | 165 | 1.8 | 3.800 ± 0.408 | vs. 87, 89, 104, 127, 179, 202, 210, 410, 544, 569 |
7 | Cirrhosis and alcoholic hepatitis (202) | 177 | 1.9 | 3.040 ± 0.665 | vs. 2, 12, 14, 75, 104, 219, 410, 467, 473, 524, 543, 544 |
5 | Heart failure and shock (127) | 179 | 1.9 | 3.300 ± 0.516 | vs. 2, 12, 14, 75, 87, 104, 219, 467, 473, 524, 543 |
4 | Major interventions on the chest (75) | 180 | 1.9 | 3.770 ± 0.540 | vs. 87, 89, 104, 127, 179, 202, 210, 410, 544, 569 |
4 | Pulmonary edema and respiratory failure (87) | 204 | 2.2 | 3.090 ± 0.598 | vs. 2, 12, 14, 75, 104, 127, 219, 410, 463, 473, 524, 543, 544 |
8 | Replacement of major joints or reimplantation of the lower limbs (544) | 305 | 3.2 | 3.395 ± 0.449 | vs. 2, 12, 14, 75, 87, 89, 104, 202, 210, 219, 467, 524, 569 |
4 | Simple pneumonia and pleurisy (89) | 325 | 3.4 | 3.100 ± 0.569 | vs. 2, 12, 14, 75, 127, 219, 410, 467, 473, 524, 543, 544 |
1 | Intracranial hemorrhage or cerebral infarction (14) | 551 | 5.8 | 3.700 ± 0.469 | vs. 87, 89, 104, 127, 179, 202, 210, 544, 569 |
Totals | 3,436 | 36.4 | 3.403 ± 0.595 |
Albuminemia at Second Dosage | Frequency n, (%) | Value, Mean Value ± SD | Prevalence in Patients over 65 Years Old, n, (%) | Prevalence in Patients below 65 Years Old, n, (%) |
---|---|---|---|---|
Marked hypoalbuminemia (<2.5 mg/dL), and | 912 (14) | 2.156 ± 0.277 | 677 (74.2) | 235 (25.8) |
p < 0.001 | ||||
Mild hypoalbuminemia (2.5–3.5 mg/dL) | 3709 (57) | 3.019 ± 0.281 | 2452 (66.1) | 1257 (33.9) |
p < 0.001 | ||||
Normal albuminemia (3.5–4.5 mg/dL) | 1847 (28.4) | 3.808 ± 0.238 | 830 (44.9) | 1017 (55.1) |
p < 0.001 | ||||
Hyperalbuminemia (>4.5 mg/dL) | 40 (0.6) | 4.678 ± 0.142 | 10 (25) | 30 (75) |
p < 0.001 |
Outcome | Albumin Level, Mean (mg/dL) ± SD | p Value (ANOVA Test) |
---|---|---|
discharged home | 3.455 ± 0.610 | Death vs. all <0.001 Transferred vs. all <0.001 Discharged to home vs. other type of discharge NS |
transferred to long-term health care facilities | 3.222 ± 0.598 | |
death | 2.839 ± 0.669 | |
other type of discharge | 3.504 ± 0.597 |
Outcome | Variable | Exp(B) | Significance | 95% CI Per Exp(B) |
---|---|---|---|---|
Death | Divorced | 2.745 | 0.029 | 1.110–6.786 |
Widow | 2.561 | 0.004 | 1.340–4.893 | |
Sex (male vs. female) | 1.376 | <0.001 | 1.153–1.641 | |
Age | 1.029 | <0.001 | 1.023–1.036 | |
Albumin at admission | 0.270 | <0.001 | 0.236–0.310 | |
Discharged home | Single | 0.811 | <0.001 | 0.724–0.997 |
Higher education | 0.765 | 0.020 | 0.609–0.959 | |
Age | 0.995 | <0.001 | 0.992–0.997 | |
Albumin at admission | 1.328 | <0.001 | 1.241–1.421 | |
Transferred to long-term health care facilities | Single | 1.213 | 0.019 | 1.033–1.424 |
Secondary | 1.637 | <0.001 | 1.358–1.973 | |
Higher | 1.798 | 0.002 | 1.237–2.613 | |
Sex (male vs. female) | 0.821 | <0.001 | 0.738–0.914 | |
Age | 1.018 | <0.001 | 1.014–1.022 | |
Albumin at admission | 0.699 | <0.001 | 0.641–0.762 | |
Other types | Single | 1.283 | <0.001 | 1.127–1.461 |
Secondary | 0.825 | 0.003 | 0.728–0.935 | |
Age | 0.989 | <0.001 | 0.986–0.992 | |
Albumin at admission | 1.399 | <0.001 | 1.295–1.512 |
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Moramarco, S.; Morciano, L.; Morucci, L.; Messinese, M.; Gualtieri, P.; Carestia, M.; Ciccacci, F.; Orlando, S.; Buonomo, E.; Legramante, J.M.; et al. Epidemiology of Hypoalbuminemia in Hospitalized Patients: A Clinical Matter or an Emerging Public Health Problem? Nutrients 2020, 12, 3656. https://doi.org/10.3390/nu12123656
Moramarco S, Morciano L, Morucci L, Messinese M, Gualtieri P, Carestia M, Ciccacci F, Orlando S, Buonomo E, Legramante JM, et al. Epidemiology of Hypoalbuminemia in Hospitalized Patients: A Clinical Matter or an Emerging Public Health Problem? Nutrients. 2020; 12(12):3656. https://doi.org/10.3390/nu12123656
Chicago/Turabian StyleMoramarco, Stefania, Laura Morciano, Luca Morucci, Mario Messinese, Paola Gualtieri, Mariachiara Carestia, Fausto Ciccacci, Stefano Orlando, Ersilia Buonomo, Jacopo Maria Legramante, and et al. 2020. "Epidemiology of Hypoalbuminemia in Hospitalized Patients: A Clinical Matter or an Emerging Public Health Problem?" Nutrients 12, no. 12: 3656. https://doi.org/10.3390/nu12123656