Low Serum Albumin Levels Predict Short‐ and Long‐Term Mortality Risk in Patients Hospitalized to General Surgery Wards

AIMS: Investigate the association of albumin levels on admission and change in levels during hospitalization of patients in general surgery wards with hospitalization outcomes. METHODS: Historical prospective data of patients hospitalized between January 2011 and December 2017. Albumin levels were classified as follows: marked hypoalbuminemia ( 4.5mg/dL). Main outcomes were length of hospitalization, 30-days and long-term mortality. RESULTS: The 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 hypoalbuminemia (n=2,824) and 3% had marked hypoalbuminemia (n=529). Hyperalbuminemia on admission was evident in 20% of the patients (n=3,490). 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 hypoalbuminemia (22%) and lower with hyperalbuminemia (0.4%). Mortality rate at the end-of-follow-up was 14% with normal albumin levels, 35% and 58% with mild and marked hypoalbuminemia, respectively. Patients with hyperalbuminemia on admission and before discharge had the best short- and long-term survival. This pattern was similar when analyzed separately in different age groups. In patients with hypoalbuminemia on admission, normalization of albumin levels before discharge was associated with lower short- (12% vs. 1%) and long-term mortality risk (42% vs. 17%). CONCLUSIONS: Low albumin levels on admission to general surgery wards are associated with increased short- and long-term mortality. Normalization of albumin levels before discharge was associated with lower mortality, compared to hypoalbuminemia before discharge. This article is protected by copyright. All rights reserved.