• Amit Akirov, Alexander Gorshtein, Chagit Adler-Cohen, Tali Steinmetz, Tzipora Shochat, and Ilan Shimon.
• Department of Medicine, Institute of Endocrinology, Beilinson Hospital, Petah Tikva, Israel.
• Intern Med J. 2020 Aug 1; 50 (8): 977-984.

BackgroundPrevious studies have reported conflicting results on the association between hypoalbuminaemia and morbidity and mortality in hospitalised patients.AimsTo investigate the association of albumin levels on admission and change in levels during hospitalisation of patients in general surgery wards with hospitalisation outcomes.MethodsHistorical prospective data of patients hospitalised between January 2011 and December 2017. Albumin levels were classified as follows: marked hypoalbuminaemia (<2.5 mg/dL), mild hypoalbuminaemia (2.5-3.5 mg/dL), normal albumin (3.5-4.5 mg/dL) and hyperalbuminaemia (>4.5 mg/dL). Main outcomes were length of hospitalisation, 30-days and long-term mortality.ResultsThe cohort included 17 930 patients (mean age 58 ± 20 years, 49% male). Most had normal albumin levels on admission (n = 11 087, 62%), 16% had mild hypoalbuminaemia (n = 2824) and 3% had marked hypoalbuminaemia (n = 529). Hyperalbuminaemia on admission was evident in 20% of the patients (n = 3490). Follow-up time was up to 7.2 years (median ± SD = 3 ± 2 years). Compared to 30-day mortality with normal albumin on admission (2%), mortality was higher with mild (9%) and marked hypoalbuminaemia (22%) and lower with hyperalbuminaemia (0.4%). The mortality rate at the end of follow up was 14% with normal albumin levels, and 35% and 58% with mild and marked hypoalbuminaemia respectively. Patients with hyperalbuminaemia on admission and before discharge had the best short- and long-term survival. This pattern was similar when analysed separately in different age groups. In patients with hypoalbuminaemia on admission, normalisation of albumin levels before discharge was associated with lower short- (12% vs 1%) and long-term mortality risk (42% vs 17%).ConclusionsLow albumin levels on admission to general surgery wards are associated with increased short- and long-term mortality. Normalisation of albumin levels before discharge was associated with lower mortality, compared to hypoalbuminaemia before discharge.© 2019 Royal Australasian College of Physicians.

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