Serum albumin and prealbumin as predictors of clinical outcomes of hospitalized elderly nursing home residents

J Am Geriatr Soc. 1993 May;41(5):545-9. doi: 10.1111/j.1532-5415.1993.tb01893.x.


Objective: To investigate the prevalence of hypoalbuminemia and hypoprealbuminemia in hospitalized, elderly, skilled nursing facility residents and to correlate these findings with clinical outcomes.

Design: Prospective cohort study.

Setting: A 300-bed community hospital.

Participants: Eighty-one hospitalized, skilled nursing facility patients, average age 83.1 years.

Interventions: None.

Outcome measures: Serum albumin and prealbumin (transthyretin) were measured at admission, mid-week, 1 week, and 1 month. Patients were followed for 90 days for the outcomes of length of hospitalization and mortality.

Results: The prevalence of hypoalbuminemia was 99% and of hypoprealbuminemia, 79%. Both means dropped significantly from admission to midweek nadirs of 25 g/L for albumin and 14 mg/L for prealbumin. Severe hypoalbuminemia at mid-week predicted mortality (RR = 4.1 95%, CI 2.0-8.5) and extended length of hospitalization (RR = 5.2 95%, CI 2.8-9.8). Severe hypoprealbuminemia predicted extended hospitalization (RR = 3.2, CI 1.5-6.7) but not mortality.

Conclusions: Hypoalbuminemia and hypoprealbuminemia are very common in this clinical setting and vary in parallel fashion over time. Severe hypoalbuminemia was a stronger predictor than hypoprealbuminemia of 90-day mortality and extended length of stay. Serum albumin on admission was not as strong a predictor of outcomes as serum albumin at mid-week.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Connecticut / epidemiology
  • Female
  • Hospital Bed Capacity, 300 to 499
  • Hospital Mortality
  • Hospitals, Community / statistics & numerical data*
  • Humans
  • Length of Stay / statistics & numerical data
  • Likelihood Functions
  • Logistic Models
  • Male
  • Outcome Assessment, Health Care / standards*
  • Patient Admission
  • Prealbumin / analysis*
  • Predictive Value of Tests
  • Prevalence
  • Prospective Studies
  • Protein-Energy Malnutrition / blood
  • Protein-Energy Malnutrition / complications
  • Protein-Energy Malnutrition / epidemiology*
  • Serum Albumin / standards*
  • Skilled Nursing Facilities


  • Prealbumin
  • Serum Albumin