Prealbumin measurement as a screening tool for protein calorie malnutrition in emergency hospital admissions: a pilot study

Clin Invest Med. 1999 Apr;22(2):44-52.

Abstract

Objective: To examine the effectiveness of prealbumin measurement as a routine diagnostic test for protein calorie malnutrition (PCM) in emergency admissions.

Design: Cohort study.

Setting: Canadian tertiary care hospital.

Patients: A total of 147 consecutive patients admitted through the emergency department, excluding psychiatric admissions, for whom a serum sample was sent to the chemistry laboratory.

Outcome measures: (1) Albumin and prealbumin levels to diagnose PCM; (2) length of stay (LOS), in-hospital mortality, and nutritional supplementation in patients with PCM; and (3) cost analysis of using prealbumin level as an admission screening test for PCM.

Results: Twenty-four per cent of the patients had at least mild PCM (prealbumin level < 160 mg/L). Albumin level (< 35 g/L) had a sensitivity of 50% and specificity of 95% in identifying PCM. The mean LOS in the patients with PCM was 16 (standard deviation 18) days, compared with 8 (SD 12) days in the patients without PCM (p < 0.0002). The in-hospital mortality rate was 17% in patients with PCM compared with 4% in patients without PCM (p < 0.02). Only 42% of patients with PCM received nutritional supplementation. Cost analysis of screening with prealbumin level projected a saving of $414 per patient screened.

Conclusions: PCM is underdiagnosed in current clinical practice and is associated with an increased LOS and mortality rate. Prealbumin is a biochemical marker that could be used as a cost-effective screening test to identify patients with PCM who may benefit from nutritional supplementation.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / analysis
  • Child
  • Child, Preschool
  • Costs and Cost Analysis
  • Emergency Medical Services*
  • Energy Intake
  • Humans
  • Length of Stay / statistics & numerical data
  • Middle Aged
  • Nutritional Support / economics
  • Pilot Projects
  • Prealbumin / analysis*
  • Prospective Studies
  • Protein-Energy Malnutrition / blood
  • Protein-Energy Malnutrition / diagnosis*
  • Protein-Energy Malnutrition / therapy
  • Serum Albumin / analysis*

Substances

  • Biomarkers
  • Prealbumin
  • Serum Albumin