Prognostic value of serum albumin levels in hospitalized adults with community-acquired pneumonia

SummaryObjectiveTo investigate whether serum albumin levels within 24 h of admission correlate with outcomes in community-acquired pneumonia (CAP).MethodsObservational analysis of a prospective cohort of adults with CAP requiring hospitalization from 1995 through 2011. Serum albumin level was the independent variable. The primary end point was 30-day mortality.ResultsDuring the study period, 3463 patients with CAP required hospitalization. The median value of albumin was 31 g/L (IQR 28–35). As levels of serum albumin decrease, the risk of complications significantly increases (P < .001). Decreased albumin levels were also associated with prolonged time to reach clinical stability (P < .001), prolonged hospital stay (P < .001), ICU admission (P < .001), the need for mechanical ventilation (P < .001), and 30-day mortality (P < .001). After adjusting for potential confounders in a multivariate logistic regression analysis, serum albumin levels at admission (−5 g/L decrease) were independently associated with a higher risk of 30-day mortality (OR 2.11, 95% CI 1.73–2.56). For predicting primary end point, hypoalbuminemia (<30 g/L) significantly increased the area under ROC curves of PSI and CURB-65 scores (P ≤ .02), and identified those patients with higher risk of complications classified into low- and high-risk groups by these scores.ConclusionsSerum albumin level within 24 h of admission is a good prognostic marker in CAP. Physicians should consider albumin level when evaluating the severity of illness in patients with CAP.