Albumin as a prognostic marker for ulcerative colitis

• Published in: World journal of gastroenterology : WJG 2017-12, Vol.23 (45), p.8008-8016
• Main Authors: Khan, Nabeel, Patel, Dhruvan, Shah, Yash, Trivedi, Chinmay, Yang, Yu-Xiao
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - therapeutic use; Adult; Aged; Biomarkers - blood; Colectomy; Colitis, Ulcerative - blood; Colitis, Ulcerative - diagnosis; Colitis, Ulcerative - therapy; Female; Follow-Up Studies; Humans; Hypoalbuminemia - blood; Immunosuppressive Agents - therapeutic use; Male; Middle Aged; Prognosis; Retrospective Cohort Study; Retrospective Studies; Risk Factors; Serum Albumin - analysis; Severity of Illness Index; Time Factors; Tumor Necrosis Factor-alpha - antagonists & inhibitors; United States; United States Department of Veterans Affairs - statistics & numerical data
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v23.i45.8008

AIM To evaluate the role of albumin at the time of ulcerative colitis(UC) diagnosis in predicting the clinical course of disease.METHODS Nationwide cohort of patients with newly diagnosed UC in the Veterans Affairs health care system was identified and divided into two categories: hypoalbuminemia(i.e.,≤ 3.5 gm/dl) or normal albumin levels(i.e.,> 3.5 gm/dl) at the time of UC diagnosis. The exposure of interest was presence of hypoalbuminemia defined asalbumin level ≤ 3.5 g/dl at the time of UC diagnosis. Patients were then followed over time to identify the use of ≥ 2 courses of corticosteroids(CS),thiopurines,anti-TNF medications and requirement of colectomy for UC management. RESULTS The eligible study cohort included 802 patients,but 92(11.4%) patients did not have their albumin levels checked at the time of UC diagnosis,and they were excluded. A total of 710 patients,who had albumin levels checked at time of UC diagnosis,were included in our study. Amongst them,536 patients had a normal albumin level and 174 patients had hypoalbuminemia. Patients with hypoalbuminemia at diagnosis had a higher likelihood of ≥ 2 courses of CS use(adjusted HR = 1.7,95%CI: 1.3-2.3),higher likelihood of thiopurine or anti-TNF use(adjusted HR = 1.72,95%CI: 1.23-2.40) than patients with normal albumin level at diagnosis. There was a trend of higher likelihood of colectomy in hypoalbuminemic patients,but it was not statistically significant(Adjusted HR = 1.7,95%CI: 0.90-3.25).CONCLUSION Hypoalbuminemia at disease diagnosis can serve as a prognostic marker to predict the clinical course of UC at the time of diagnosis.