THESIS 2

 INTRODUCTION:-

FACTORS INFLUENCING THE DEVELOPMENT OF HYPOALBUMINEMIA AND ITS OUTCOMES

Problem Statement:-

In adult humans, albumin is the most abundant plasma protein with a concentration ranging from 35 to 50 g/L. Albumin represents 50% of the total protein content of plasma, with globulins making up most of the rest. It is a single peptide chain of 585 amino acids in a globular structure. The molecular weight of albumin is approximately 66 kDa, and it has a half-life of 21 days. Albumin is exclusively synthesized by the liver, initially a pre-proalbumin and then proalbumin, which in the Golgi apparatus is converted to albumin, which is the final form secreted by the hepatocyte. The synthetic rate is about 10 to 15 grams per day and then secreted into the circulation of which around 40% remains in circulation with a fraction moving from the intravascular to the interstitial space. Factors that stimulate albumin synthesis include the action of hormones such as insulin and growth hormone. Albumin production may be inhibited by pro-inflammatory mediators such as interleukin-6 (IL-6),  interleukin-1 (IL-1) and tumor necrosis factor. In fetal life, alpha-fetoprotein (AFP) produced by the liver and yolk sac is the most abundant plasma protein. AFP is thought to be the fetal counterpart of albumin, and both are transcribed by genes located close together on chromosome 4. Approximately 100 variant forms of albumin have been described.

Albumin has several physiological roles. One of the most important is to maintain the oncotic pressure within the vascular compartments preventing leaking of fluids into the extravascular spaces. It accounts for around 80% of the colloid osmotic pressure. Additionally, albumin functions as a low-affinity, high-capacity carrier of several different endogenous and exogenous compounds acting as a depot and a carrier for these compounds. Binding of compounds to albumin may reduce their toxicity such as in the case of unconjugated bilirubin in the neonate and drugs. Also, albumin binds at least 40% of the circulating calcium and is a transporter of hormones such as thyroxine, cortisol, testosterone, among others. Albumin also is the main carrier for fatty acids and has significant anti-oxidant properties. Albumin is also involved with maintaining acid-base balance as it acts as a plasma buffer. Albumin is used as a marker of nutritional status and disease severity in particular in chronic and critically ill patients. Renal and gut loss of albumin may account for around 6% and 10% respectively of albumin loss in healthy individuals. A decrease in serum albumin levels below the reference interval hypoalbuminemia. This article reviews the causes and diagnosis of hypoalbuminemia.

Hypoalbuminemia is a medical sign in which the level of albumin in the blood is low. This can be due to decreased production in the liver, increased loss in the gastrointestinal tract or kidneys, increased use in the body, or abnormal distribution between body compartments. Patients often present with hypoalbuminemia as a result of another disease process such as malnutrition as a result of severe anorexia nervosa, sepsis, cirrhosis in the liver , nephrotic syndrome in the kidneys, or protein losing enteropathy in the gastro intestinal tract . One of the roles of albumin is being the major driver of oncotic pressure (protein concentration within the blood) in the bloodstream and the body. Thus, hypoalbuminemia leads to abnormal distributions of fluids within the body and its compartments. As a result, associated symptoms include edema in the lower legs, ascites in the abdomen, and effusions around internal organs. Laboratory tests aimed at assessing liver function diagnose hypoalbuminemia. Once identified, it is a poor prognostic indicator for patients with a variety of different diseases. Yet, it is only treated in very specific indications in patients with cirrhosis and nephrotic syndrome. Treatment instead focuses on the underlying cause of the hypoalbuminemia. Albumin is an acute negative phase respondent and not a reliable indicator of nutrition status.

Pathophysiology:- 

Aim:-

TO EVALUATE THE OUTCOMES IN PATIENTS WITH HYPOALBUMINEMIA AND THE MOST COMMON CAUSE OF HYPOALBUMINEIA IN MY STUDY POPULATION

Objectives:-

1. Summarize the risk factor of developing hypoalbuminemia.

2. 

STUDY DESIGN :-

Prospective study design with analysis of factors influencing the outcome of the patients with Hypoalbuminemia

INCLUSION CRITERIA:-

1.Includes all above 15yrs age group

2.Includes both the gender

3.Includes patients who have given consent to this study

EXCLUSION CRITERIA:-

1.All patients below 15yrs of age group

2. Patients who aren’t willing to participate in the study (non-consenting individuals).

PLACE OF STUDY: Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally.

STUDY PERIOD:   November 2023 - October 2025

STUDY DESIGN: Prospective Observational Qualitative study.

SAMPLE SIZE: Proposed No. of cases to be studied = 50

CASE PROFORMA:-

SERIAL NO:

NAME:

AGE:

OP/IP NO.:

EDUCATION: 

OCCUPATION: 

SOCIOECONOMIC STATUS: 

PHONE NUMBER: 

ADDRESS:

Complaints:- 

1. fever

2. weight loss

3. pedal edema

4. fatigue

5. generalised weakness

PAST HISTORY:-

Diabetes Mellitus

Hypertension

Thyroid disorders 

PERSONAL HISTORY:-

Alcohol history

Smoking history

Appetite 

Bowel and Bladder habits

 

FAMILY HISTORY:-

History of similar illness in family

GENERAL EXAMINATION 

 Pallor                                                       

 Icterus

 Clubbing                               

 Cyanosis                                                                   

 Facial Puffiness

 Pedal Edema

RESPIRATORY EXAMINATION:

Movements of chest:

Percussion:

Air entry:

Breath sounds:

CARDIOVASCULAR SYSTEM: 

Heart sounds:

 JVP:

 Added sounds:

GASTROINTESTINAL SYSTEM: 

Inspection: Palpation:

Shape of abdomen organomegaly

Umbilicus liver span

Percussion: Auscultation:

Shifting dullness Bowel sounds 

                                           

CENTRAL NERVOUS EXAMINATION:

Higher mental functions:

Motor and sensory system:

Cerebellar functions:

Meningeal signs:

INVESTIGATIONS:-

1. Haemogram

2. Cue

3. Lft 

 

OUTCOMES:-

1) Morbidity

CONSENT: 

I/WE, relative of the patient have read and understood the information provided in the patient information sheet and have been informed the purpose of the evaluation in the language I understand.

I am aware of the fact that I may not derive any benefit from the evaluation and that I deserve the right to opt out of the study at any point of time.

I willingly agree to participate in this study.

Patients sign/thumb impression:                             witness sign/thumb impression.

Name:                                                                            name:

Date:                                                                               date:

 

Residents sign:

Resident name:

date: 

REFERENCES

1.

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2.

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3.

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4.

Brock F, Bettinelli LA, Dobner T, Stobbe JC, Pomatti G, Telles CT. Prevalence of hypoalbuminemia and nutritional issues in hospitalized elders. Rev Lat Am Enfermagem. 2016 Aug 08;24:e2736. [PMC free article] [PubMed]

5.

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6.

Gatta A, Verardo A, Bolognesi M. Hypoalbuminemia. Intern Emerg Med. 2012 Oct;7 Suppl 3:S193-9. [PubMed]

7.

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