Serum Hypoalbuminemia Is a Long-Term Prognostic Marker in Medical Hospitalized Patients, Irrespective of the Underlying Disease

Hypoalbuminemia is common in hypoalbuminemia-associated disorders (HAD), e.g., liver and kidney disease. We hypothesize that hospitalized patients with hypoalbuminemia have poor prognosis irrespective of their underlying disease. Records of patients admitted to Medicine (2010-2018), with and without HAD were analyzed, comparing low (<35 g/L) to normal serum albumin. Mann-Whitney and Chi-squared tests were used, and a logistic regression model was applied. Patients: 14,640 were admitted; 9759 were analyzed (2278 hypoalbuminemia: 736 HAD, 1542 non-HAD). All patients, and the subgroups with (as expected) and without HAD had worse outcomes. Specifically, in patients without HAD, those with hypoalbuminemia (n = 1542) vs. normal albumin (n = 6216) were older, had a higher Charlson Comorbidity Index (CCI, 5 vs. 4), longer median hospital stay (5 vs. 4), higher one year re-admission rate (49.9% vs. 39.8%), and one year mortality (48.9% vs. 15.3%, p < 0.001 for all). LR model predicting 3 month, 1 year and 5 year mortality confirmed the predictive power of albumin (1 year: OR = 4.49 for hypoalbuminema, p < 0.01). Hypoalbuminemia portends poor long-term prognosis in hospitalized patients regardless of the underlying disease and could be added to prognostic predictive models.