High CRP values, low albumin levels predict mortality in ED patients

High nutritional risk and elevated C-reactive protein (CRP) values independently correlate with hypoalbuminaemia, while both parameters and low serum albumin levels separately predict mortality, according to a study.

The authors prospectively enrolled adult patients in the medical emergency department (ED) of a Swiss tertiary care centre. Multivariate regression analyses were performed to examine the relationships of CRP and Nutritional Risk Screening 2002 as markers of inflammation and poor nutritional status, respectively, with low serum albumin levels and mortality.

A total of 2,465 patients were included, of whom 1,019 (41 percent) had low serum albumin levels (<34 g/L), 619 (25.1 percent) had increased nutritional risk (Nutritional Risk Screening 2002 ≥3), and 1,086 (44.1 percent) had CRP values >20 mg/L.

In multivariate analyses adjusted for age, gender, diagnosis, and comorbidities, results showed that elevated CRP values (adjusted odds ratio [aOR], 10.51, 95 percent confidence interval [CI], 7.51–14.72; p<0.001) and increased malnutrition risk (aOR, 2.87, 95 percent CI, 1.98–4.15; p<0.001) were associated with low serum albumin levels, even adjusting for both parameters.

Elevated CRP values, increased nutritional risk, and low serum albumin levels each predicted 30-day mortality, with areas under the curve of 0.77, 0.70, and 0.75, respectively. Combination of all parameters demonstrated an area under the curve of 0.82 to predict mortality.

“Combining [these parameters] during initial evaluation of patients in EDs facilitates mortality risk stratification,” the authors said.

“Low serum albumin levels resulting from inflammation-induced capillary leakage or disease-related anorexia during acute illness are associated with poor outcomes,” they noted.