Predictors of Clinical Outcome

The best marker of injury is serum albumin concentration. It is an excellent predictor of survival in patients with cancer and other types of illnesses (Table 6). More than 20 studies have shown that a serum albumin level below normal can be used to predict disease outcomes in many groups of patients. One of the first studies in this area was a Veterans Administration study in which 30-day mortality rates were evaluated for a total of 2060 consecutive medical and surgical admissions. Investigators found that 24.7% of the patient population had a low albumin level defined as 3.4g/dl or lower. The 30-day mortality rate for hypoalbuminemia patients was 24.6% compared to 1.7% for patients with a normal albumin level. These investigators demonstrated an excellent correlation between serum albumin levels and 30-day mortality rates. A 1-g decrease in serum albumin levels (3.5 to 2.5g/dl) translated into a 33% increase in mortality. Patients with an average albumin level of 1.8 g/dl had a mortality rate of 65%. It is interesting to note that of 15 hypoalbuminemia patients in this study who were provided with total parenteral nutrition, only 1 died (7% mortality).

Protein malnutrition is associated with a greater risk for infection, especially fungal infections. In one

Table 6 Serum albumin and mortality

Patient population Mortality

With normal albumin With low albumin (%) Increased risk (-fold) Albumin cutoff level (g/dl)

n %

VA hospital

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