Original article Prevalence and significance of hypoalbuminemia in an internal medicine department ☆ Filippo Numeroso ⁎ , Angela L. Barilli 1 , Roberto Delsignore 1 Department of Internal Medicine and Biomedical Sciences of the University of Parma, Italy, Via Gramsci 14, 43100, Parma, Italy Received 14 January 2007; received in revised form 16 April 2007; accepted 23 April 2007 Available online 18 April 2008 Abstract Background: Serum albumin is commonly measured in hospitalized patients. It has habitually been included among the parameters used for nutritional assessment, and recently its use has become even more widespread. Yet, no data are available in the literature about the prevalence and clinical significance of hypoalbuminemia in patients hospitalized in an internal medicine ward. The aim of this study was to investigate the prevalence and clinical significance of hypoalbuminemia in in-hospital internal medicine patients. Methods: We retrospectively evaluated the albumin level of patients admitted to the Department of Internal Medicine and Biomedical Sciences of the University of Parma during the year 2000. We then evaluated sex, age, nutritional status, some laboratory parameters, associated diseases, and length of hospitalization in hypoalbuminemic patients in comparison with a group of patients without hypoalbuminemia. Results: Hypoalbuminemics (46.5% of patients) were older, more frequently anemic, and had a higher erythrocyte sedimentation rate (ESR) and longer hospitalization; they were mostly normal weight or overweight. These patients also had chronic liver (18.6% vs. 4.5%), onco- hematological (33.8% vs. 12%), and infectious diseases (13.4% vs. 2.3%) and nephropathies (6.3% vs. 2%) more often than patients without hypoalbuminemia. The presence of onco-hematological diseases was related to anemia (O.R. = 5.73; 95% CI: 3.184–10.310), lymphopenia (O.R. = 2.76; 95% CI: 1.584–4.801), and hypoalbuminemia (O.R. = 2.5; 95% CI: 1.178–5.307). Conclusions: Hypoalbuminemia is very frequent in an internal medicine ward. In this setting, serum albumin is related to the length of hospitalization and to other parameters with a well-known prognostic value (age, hemoglobin) and clinical usefulness (ESR). It may also play a role in the evaluation of the possible association of onco-hematological diseases. © 2008 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. Keywords: Albumin; Nutritional status; Onco-hematological diseases 1. Introduction Albumin is the most abundant plasma protein (50–60% of total). It exerts a function of “non-specific” carrier (hormones, drugs, bilirubin) and contributes (80%) to the maintenance of the normal colloid osmotic (oncotic) plasma pressure and, thus, to the regulation of water balance and to the maintenance of plasma volume. The normal value (n.v.) of serum albumin is 3.5–5 g/dl; depending on the interaction between various factors, such as hepatic synthesis, body fluid distribution, and rate of degradation. Therefore, hypoalbuminemia (b 3.5 g/dl) can be due to alterations of the abovementioned processes: reduced production, for decreased hepatic synthesis (e.g., cirrhosis) and/or protein intake (e.g., malnourishment); increased loss, for increased catabolism and/or enteric (e.g., protido- dispersing bowel disease), renal (e.g., nephrotic syndrome), or cutaneous loss (e.g., burns); altered distribution, for hemodilution; and reduced lymphatic clearance. European Journal of Internal Medicine 19 (2008) 587 – 591 www.elsevier.com/locate/ejim ☆ F. Numeroso was responsible for the study design, data collection and analysis, and manuscript writing, with contributions from all others authors. A.L. Barilli was the trial statistician. The paper has been read and approved by all authors and every author contributed to the drafting and reviewing of the paper. ⁎ Corresponding author. via Govone 100, I-20155, Milano, Italy. Tel.: +393334604349, Tel.: +0039521903267; fax: +0039521702490. E-mail address: ffilo@libero.it (F. Numeroso). 1 Tel.: +0039521903267; fax: +0039521702490. 0953-6205/$ - see front matter © 2008 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.ejim.2007.04.029