Association between prealbumin, all-cause mortality, and response to nutrition treatment in patients at nutrition risk. Secondary analysis of a randomized controlled trial

Bretscher, Céline; Buergin, Michelle; Gurzeler, Gianna; Kägi-Braun, Nina; Gressies, Carla; Tribolet, Pascal; Lobo, Dileep N.; Evans, David C.; Stanga, Zeno; Mueller, Beat; Schuetz, Philipp; for the EFFORT study team

Abstract

Background: Because of the shorter half-life as compared with albumin, serum prealbumin concentrations have been proposed to be useful nutrition biomarkers for the assessment of patients at nutrition risk. In a post hoc analysis of patients at nutrition risk from a randomized controlled nutrition trial, we tested the hypothesis that (1) prealbumin is associated with higher all-cause 180-day mortality rates and that (2) individualized nutrition support compared with usual-care nutrition more effectively improves survival at 30 days in patients with low prealbumin levels compared with patients with normal prealbumin levels. Methods: We performed a prespecified cohort study in patients included in the pragmatic, Swiss, multicenter randomized controlled EFFORT trial comparing the effects of individualized nutrition support with usual care. We studied low prealbumin concentrations (<0.17 g/L) in a subgroup of 517 patients from one participating center. Results: A total of 306 (59.2%) patients (mean age 71.9 years, 53.6% men) had low admission prealbumin levels (<0.17 g/L). There was a significant association between low prealbumin levels and mortality at 180 days (115/306 [37.6%] vs 47/211 [22.3%], fully adjusted hazard ratio [HR]=1.59, 95% CI 1.11–2.28; P = 0.011). Prealbumin levels significantly improved the prognostic value of the Nutritional Risk Screening total score regarding mortality prediction at short- and long-term. The difference in mortality between patients receiving individualized nutrition support and usual-care nutrition was similar for patients with low prealbumin levels compared with patients with normal prealbumin levels (HR=0.90 [95% CI=0.51–1.59] vs HR=0.88 [95% CI=0.35–2.23]) with no evidence for interaction (P = 0.823). Conclusion: Among medical inpatients at nutrition risk, low admission prealbumin levels correlated with different nutrition markers and higher mortality risk, but patients with low or high prealbumin levels had a similar benefit from nutrition support. Further studies should identify nutrition markers that help further personalize nutrition interventions.

Citation

Bretscher, C., Buergin, M., Gurzeler, G., Kägi-Braun, N., Gressies, C., Tribolet, P., Lobo, D. N., Evans, D. C., Stanga, Z., Mueller, B., Schuetz, P., & for the EFFORT study team. (2023). Association between prealbumin, all-cause mortality, and response to nutrition treatment in patients at nutrition risk. Secondary analysis of a randomized controlled trial. Journal of Parenteral and Enteral Nutrition, 47(3), 408-419. https://doi.org/10.1002/jpen.2470

• Journal Article Type: Article
• Acceptance Date: Dec 29, 2022
• Online Publication Date: Jan 1, 2023
• Publication Date: 2023-03
• Deposit Date: Jan 5, 2023
• Publicly Available Date: Jan 5, 2023
• Journal: Journal of Parenteral and Enteral Nutrition
• Print ISSN: 0148-6071
• Electronic ISSN: 1941-2444
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Volume: 47
• Issue: 3
• Pages: 408-419
• DOI: https://doi.org/10.1002/jpen.2470
• Keywords: biomarker, visceral proteins, malnutrition, nutritional support, outcomes, prealbumin
• Public URL: https://nottingham-repository.worktribe.com/output/15714723
• Publisher URL: https://aspenjournals.onlinelibrary.wiley.com/doi/10.1002/jpen.2470
• Additional Information: This is the peer reviewed version of the following article: Bretscher, C., Buergin, M., Gurzeler, G., Kägi-Braun, N., Gressies, C., Tribolet, P., Lobo, D.N., Evans, D.C., Stanga, Z., Mueller, B., Schuetz, P. and (2023), The association between prealbumin, all-cause mortality and response to nutritional treatment in patients at nutritional risk. Secondary analysis of a randomized-controlled trial. J Parenter Enteral Nutr.. Accepted Author Manuscript, which has been published in final form at https://doi.org/10.1002/jpen.2470.