Admission serum albumin concentrations and response to nutritional therapy in hospitalised patients at malnutrition risk: Secondary analysis of a randomised clinical trial

Céline Bretschera; Fabienne Boesiger; Nina Kaegi-Braun; Lara Hersberger; Dileep N Lobo; David C Evans; Pascal Tribolet; Filomena Gomes; Claus Hoess; Vojtech Pavlicek; Stefan Bilz; Sarah Sigrist; Michael Brändle; Christoph Henzen; Robert Thomann; Jonas Rutishauser; Drahomir Aujesky; Nicolas Rodondi; Jacques Donzé; Zeno Stanga; Beat Mueller; Philipp Schuetz

doi:10.1016/j.eclinm.2022.101301

Admission serum albumin concentrations and response to nutritional therapy in hospitalised patients at malnutrition risk: Secondary analysis of a randomised clinical trial

EClinicalMedicine. 2022 Feb 11:45:101301. doi: 10.1016/j.eclinm.2022.101301. eCollection 2022 Mar.

Authors

Céline Bretschera¹, Fabienne Boesiger¹, Nina Kaegi-Braun¹, Lara Hersberger¹, Dileep N Lobo², David C Evans³, Pascal Tribolet^{1

4}, Filomena Gomes^{1

5}, Claus Hoess⁶, Vojtech Pavlicek⁶, Stefan Bilz⁷, Sarah Sigrist⁷, Michael Brändle⁷, Christoph Henzen⁸, Robert Thomann⁹, Jonas Rutishauser¹⁰, Drahomir Aujesky¹¹, Nicolas Rodondi^{11

12}, Jacques Donzé^{13

14}, Zeno Stanga¹⁵, Beat Mueller^{1

16}, Philipp Schuetz^{1

16}

Affiliations

¹ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse, Aarau CH-5001, Switzerland.
² Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, Queen's Medical Centre, Nottingham Biomedical Research Centre, National Institute for Health Research (NIHR), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK.
³ Trauma / Critical Care Surgery, Ohio Health Grant Medical Center, Columbus, OH, USA.
⁴ Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.
⁵ The New York Academy of Sciences, New York, NY, USA.
⁶ Internal Medicine, Kantonsspital Münsterlingen, Münsterlingen, Switzerland.
⁷ Internal Medicine and Endocrinology, Kantonsspital St Gallen, St Gallen, Switzerland.
⁸ Internal Medicine, Kantonsspital Luzern, Luzern, Switzerland.
⁹ Internal Medicine, Bürgerspital Solothurn, Solothurn, Switzerland.
¹⁰ Internal Medicine, Kantonsspital Baselland Standort Bruderholz, Switzerland.
¹¹ Department of General Internal Medicine, Switzerland.
¹² Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
¹³ Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
¹⁴ Medical Faculty of the University of Basel, Basel, Switzerland.
¹⁵ Division of Diabetology, Endocrinology, Nutritional Medicine, and Metabolism, Switzerland.
¹⁶ Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Abstract

Background: Historically, admission serum albumin concentrations have been considered useful biochemical markers for nutrition assessment. However, there is a lack of randomised trial data investigating whether low albumin concentrations are helpful for identifying patients benefitting from nutritional support.

Methods: This study was a secondary analysis of the EFFORT trial, a Swiss-wide multicentre, randomised controlled trial comparing individualised nutritional support with usual care nutrition in medical inpatients from April 1, 2014, to February 1, 2018. 1389 of 2028 patients at nutritional risk with available albumin concentrations on admission were included. The primary endpoint was all-cause mortality within 30 and 180 days. Patients were stratified into groups of low or normal albumin based on the albumin cut-off of 30 g/L. ClinicalTrials.gov number, NCT02517476.

Findings: 1389 patients (mean age, 73.1 (SD 3.5) years; 747 (53.8%) men) were included and 676 (48.7%) had low serum albumin concentrations at admission (<30 g/L). Mortality at 180 days was significantly increased in the low albumin group compared with patients with normal albumin concentrations (219/676 (32.4%) vs. 162/713 (22.7%), fully adjusted HR 1.4, 95%CI 1.11 to 1.77, p = 0.005]. Effects of nutritional support on 30-day mortality were similar for patients with low compared to patients with normal albumin concentrations (HR 0.68, 95%CI 0.44 to 1.05 vs. HR 0.70, 95%CI 0.41 to 1.20), with no evidence for a subgroup effect (p for interaction=0.97).

Interpretation: Based on this secondary analysis of a randomised trial, low admission serum albumin concentrations in hospitalised, non-critically ill, medical patients at nutritional risk had prognostic implications and indicated higher mortality risk but were not helpful in selecting patients for nutritional interventions.

Funding: The Swiss National Science Foundation (SNSF) (PP00P3_150531) and the Research Council of the Kantonsspital Aarau (1410.000.058 and 1410.000.044) provided funding for the EFFORT trial.

Keywords: C-reactive protein; Inflammation; Malnutrition; Nutritional support; Outcomes; Serum albumin.

Associated data

ClinicalTrials.gov/NCT02517476

Grants and funding

MR/P021220/1/MRC_/Medical Research Council/United Kingdom