IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861. Volume 6, Issue 2 (Mar.- Apr. 2013), PP 01-06 www.iosrjournals.org www.iosrjournals.org 1 | Page Use of Plasma Prealbumin concentration in assessment of nutritional status of adult patients admitted in rural Hospitals in Rivers State, Nigeria *Orluwene Chituru Godwill;*Nkoyo Ntuen. B.Med. Sci; MBBS; FMCPath.MBBS, FMCPath * Department of Chemical Pathology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria Abstract: Protein-energy malnutrition (PEM) is a common condition among patients admitted to hospitals, and it is associated with a worse prognosis and increased mortality. Although several screening systems are now available, PEM is still poorly recognized especially in the rural settings as there is no consensus on which test is more reliable and feasible in clinical practice. Prealbumin (PAB) is a potential useful PEM marker because its serum concentrations are closely related to early changes in nutritional status. We studied PEM prevalence and PAB serum concentrations in 120 hospitalized patients. The Detailed Nutritional Assessment (DNA) was used as the reference method to determine PEM. PAB performance was compared with that of 2 other methods, the Subjective Global Assessment (SGA) and the Prognostic Inflammatory and Nutritional Index score (PINI). According to the DNA reference method, 51% of patients were classified with mild malnutrition and 23% with severe malnutrition. PAB showed the best concordance with the standard DNA method (concordance index, 80%) and a good sensitivity/specificity profile (84.9%/78.9%) compared with SGA and PINI. We conclude that PAB could represent a feasible and reliable tool in the evaluation of nutritionalstatus, especially in rural settings where it is difficult to obtain a more detailed and comprehensive nutritional assessment such as the DNA. Keywords: Protein-energy Malnutrition, Prealbumin, Admitted-adult-patients, rural- hospitals, Rivers State. I. Introduction Protein-energy malnutrition (PEM) is a chronic or acute lean body protein loss that leads to a state of specific nutrient deficiency that produces a measureable change in body function. PEM is associated with a worse outcome during illness and may be reversed by conversion to an anabolic state. PEM is common in hospitalized patients and is associated with increased mortality [1,2]; 30-60% of patients hospitalized for acute illness are malnourished, and nutritional status has been shown to deteriorate during hospitalization [3]. Reasons for this high prevalence include poor recognition and monitoring of nutritional status and inadequate intake of nutrients during hospitalization [4]. Malnutrition is also a major problem among residents in long-term care facilities. Furthermore, patients admitted to the hospital may already be malnourished or at risk of malnutrition. For many diseases, implementation of validated procedures for the early identification of malnourished patients is important for improving treatment response. Anthropometric measurement (e.g. of triceps skin-fold thickness or arm-muscle circumference), an early method of nutritional assessment, has been shown to be an inaccurate indicator of nutritional status [2]. Several tools to assess malnutrition have been subsequently developed, many based on subjective evaluation from the operator, such as the Subjective Global Assessment (SGA) [5,6]. This method is based on the assessment of conditions associated with risk of malnutrition and on a physical examination that includes relevant features such as weight loss and loss of subcutaneous fat. A patient generated SGA is an alternative tool that includes data provided by the patient [7]. The Mini Nutritional assessment has been developed specifically for geriatric patients. Like the SGA, it includes evaluation of risk factors associated with malnutrition and additional information on nutritional habits [8]. The use of subjective assessment is very skill dependent and can result in underestimation of malnutrition risk. Alternative methods are based on the evaluation of individual biochemical variables, such as measurement of prealbumin (PAB) [9-11] or retinol binding protein (RBP) [12], or of multiple variables, as in the Prognostic Inflammatory and Nutritional Index (PINI) score [13], which includes evaluation of albumin,∝1- acid glycoprotein, and C-reactive peptide (CRP). Other tools, such as the Detailed Nutritional Assessment (DNA) [14], are based on the combination of both approaches and include history, physical examination, and biochemical data. An international consensus on a reference method is yet to be established. The DNA can be considered one of the most comprehensive methods, but it is time-consuming, costly, skill dependent, and unsuitable for large scale use. Therefore, there is a need for a method that is easy to use inclinical practice and