Serum Albumin as an Independent Predictor of Mortality among Older Veterans Discharged from Recuperative Care

Incident Serum Albumins (SA) have been extensively studied as a prognostic indicator in community-dwelling and hospitalized older adults. A meta-analysis showed the SA mean value for community-dwelling older adults was 4.1 g/dL and for hospitalized older adults was 3.6 g/dL [1]. Studies of community-dwelling older adults consistently demonstrate a strong inverse association between SA and the risk of mortality with a clear risk gradient demonstrated even within the reference range for SA [1-5]. Further, the incident SA remains significantly associated with mortality risk throughout the subsequent 12 years [1-4]. In contrast, studies of hospitalized older adults indicate that SA is an indicator of short-term mortality risk. In this setting, a strong inverse association has been identified between SA and the risk of mortality during the hospitalization and for up to 12 months post-discharge [1,6-9]. SA has not been shown to be a predictor of long-term survival among hospitalized patients [1,9]. This finding is consistent with the fact that SA is a negative acute phase reactant and that its concentration drops in response to acute inflammatory conditions; in this sense, SA has been considered an indicator of illness severity among hospitalized older adults and may not reflect an individual’s baseline health status [1,9].