Hypoalbuminemia, An Independent Risk Factor for Severity and Mortality Affects One Third of Patients in Acute Pancreatitis: Multicenter Prospective International Cohort Analysis

Introduction: The incidence and medical costs of acute pancreatitis (AP) are on the rise, and severe cases still have a 30% mortality rate. We aimed to evaluate hypoalbuminemia as a risk factor and the prognostic value of human serum albumin in AP. Methods: Data of 2461 patients were extracted from the international, prospective, multicenter AP registry of the Hungarian Pancreatic Study Group. Data of patients with albumin measurement in the first 48 hours (n=1149) and anytime during hospitalization (n=1272) was analyzed. Multivariate binary logistic regression and Receiver Operator Characteristic curve analysis were used. Results: The prevalence of hypoalbuminemia (<35g/L) was 19% on-admission and 35.7% during hospitalization. Hypoalbuminemia dose-dependently increased the risk of severity, mortality, local complications, and organ failure and is associated with longer hospital stay. The predictive value of hypoalbuminemia on-admission was poor for severity and mortality. Severe hypoalbuminemia (<25 g/L) was an independent risk factor for severity (OR: 48.761; CI:25.276-98.908) and mortality (OR:16.83; CI: 8.32-35.13). Albumin loss during AP was strongly associated with severity (p<0.001) and mortality (p=0.002). Conclusion: Hypoalbuminemia is an independent risk factor of severity and mortality in AP, and it shows a dose-dependent relationship with local complications, organ failure, and length of stay.