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Associated changes in systemic inflammation, prealbumin, and nutrient intake in elderly recuperative care patients

Dennis RA, Johnson LE, Roberson PK, Heif M, Bopp MM, Cook J, Sullivan D. Associated changes in systemic inflammation, prealbumin, and nutrient intake in elderly recuperative care patients. Poster session presented at: American Geriatrics Society Annual Meeting; 2007 May 4; Seattle, WA.


Purpose: Determine the specificity of prealbumin (PA) as an indicator of the adequacy of average daily energy intake (EI) in older adults admitted for recuperative and rehabilitative care. Methods: 36 male patients [33 white, 3 black; ave age = 80.5yr (range = 69-92yr)] were monitored daily during their stays on a transitional care unit. Serum PA and five markers of inflammation including C-reactive protein (CRP), tumor necrosis factor and its soluble receptors I and II, and interleukin-6 were measured at admission and discharge [ave length of stay = 23d (range = 8-70d)]. Detailed calorie counts were performed daily and expressed as a percentage of energy requirements predicted by the Harris-Benedict equation. For the analysis, PA and EI were dichotomized according to net increase or decrease. Results: An improvement in EI between the first 5 days after admission and the last 5 days prior to discharge was associated with an increase in prealbumin (P = 0.05).The change in prealbumin was also inversely associated with levels of the five inflammatory makers at admission, discharge, and as net change during the hospital stay (P < 0.05 all analyses). The most powerful predictor of an increase in prealbumin by multivariable logistic regression was a decrease in CRP (Odds ratio 1.32, 95%CI 1.02 to 1.71, P = 0.001). After adjustment for any of the inflammatory markers, increased EI was no longer significantly associated with an improvement in PA. Conclusion: For older recuperative care patients, an improvement in PA during hospitalization is associated with an improvement in EI. However, inflammation or changes in the severity of inflammation appear to be a much more powerful determinant of the change in the serum PA concentration. This suggests that PA is not a specific marker for the adequacy of nutrient intake in this population. These results are currently being reevaluated in a much larger study of this patient population.

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