Plasma albumin in patients with severe anorexia nervosa admitted to a specialized medical unit

Abstract

Objective: Anorexia nervosa (AN) is a condition characterized by chronic malnutrition. This study aims to determine the frequency of hypoalbuminemia in individuals with severe, medical unstable AN and its associations with inflammation and mortality.

Method: Data were collected from electronic health records on patients admitted to a specialized, medical unit in Denmark between 2017 and 2021. A total of 159 records were initially registered, with 127 meeting the inclusion criteria. Clinical characteristics, laboratory values and vital signs were analyzed. Patients were divided into groups based on their plasma albumin (PA) levels, being hypoalbuminemic (<36 g/L), normoalbuminemic (36-50 g/L), and hyperalbuminemic (>50 g/L), respectively. Statistical analyses were made using Welches t-test, Fisher's exact and a multivariable logistic regression was performed to assess the association between albumin status and mortality, adjusting for BMI and illness duration.

Results: 78.6 % of patients exhibited normoalbuminemia, 7.1 % were hypoalbuminemic, and 14.3 % were hyperalbuminemic. The hypoalbuminemic group had higher mean body temperature (p = 0.041), higher mean platelet count (p = 0.046), and a lower mean hemoglobin level (p = 0.046). Mortality was strikingly higher in the hypoalbuminemic group with 4 (44 %) deceased, compared to 5 (5.1 %) in the normoalbuminemic group (p = 0.012) during the 2017-2021 period, with no statistically significant difference in age between the two groups (p = 0.067). Logistic regression revealed a significantly increased risk of death in the hypoalbuminemic group (OR = 6.39, p = 0.038).

Discussion: Despite the severity of the illness, most patients with AN maintained normal PA levels, probably due to adaptive physiological mechanisms. PA level assessments could aid in identifying high-risk patients, as hypoalbuminemia was associated with inflammation and increased mortality.

Conclusion: Despite significant nutritional restrictions, even individuals with severe and extreme AN maintain normal PA levels. Hypoalbuminemia was associated with increased mortality.

Keywords: Albumin; Anorexia nervosa; Hypoalbuminemia; Inflammation; Malnutrition; Mortality.