Low albumin predicts death, TB, weight loss in Tanzanians starting ART
Low serum albumin independently predicted death, pulmonary tuberculosis, severe anemia, and weight loss in a 21-month study of 2145 Tanzanian adults starting antiretroviral therapy (ART).
Albumin in the main protein in human blood plasma. It helps move many small molecules through the blood, including bilirubin, calcium, progesterone, and medications. Albumin levels can indicate liver disease or kidney disease. Research has suggested that low serum albumin levels may predict the clinical course of people with HIV infection.
To test that hypothesis, researchers measured serum albumin every month in 2145 Tanzanian adults who had enrolled in a multivitamin trial and were starting ART. The investigators kept track of mortality, morbidity, and body measurement outcomes for a median of 21.2 months. They used proportional hazard models to identify associations between albumin levels and mortality, morbidity, and nutritional outcomes.
People with a serum albumin concentration below 35 g/L when they started ART had more than a 4 times higher risk of death during follow-up than people with a higher serum albumin (adjusted hazard ratio 4.52, 95% CI 3.37 to 6.07, P < 0.001).
Albumin below 35 g/L was also independently associated with development of pulmonary tuberculosis (P < 0.001), severe anemia (P < 0.001), wasting (P = 0.002), and more than 10% weight loss (P = 0.012).
Additional statistical analyses indicated that serum albumin levels below 38 g/L were associated with a higher risk of death or development of pulmonary TB. Serum albumin concentration was not related to changes in CD4 counts (P = 0.121).
“Serum albumin concentrations can identify adults initiating ART who are at high risk for mortality and selected morbidities,” the researchers conclude. They call for “future research . . . to identify and manage conditions that reduce the serum albumin concentration.”
Source: Christopher R. Sudfeld, Sheila Isanaka, Said Aboud, Ferdinand M. Mugusi, Molin Wang, Guerino E. Chalamilla, Wafaie W. Fawzi. Association of serum albumin concentration with mortality, morbidity, cd4 T-cell reconstitution among Tanzanians initiating antiretroviral therapy. Journal of Infectious Diseases. 2013; 207: 1370-1378.
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Source: IAS
