Serum albumin level and physical disability as predictors of mortality in older persons.
Serum albumin level and physical disability as predictors of mortality in older persons.
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DOI：
10.1001/jama.1994.03520130074036
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发表时间：
1994-10
期刊：
影响因子：
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通讯作者：
M. Corti;J. Guralnik;M. Salive;J. Sorkin
中科院分区：
文献类型：
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作者：
M. Corti;J. Guralnik;M. Salive;J. Sorkin
目的研究老年人群血清白蛋白水平与全因死亡率之间的关系，并评估白蛋白水平结合身体残疾状况在预测死亡率中的作用。设计：队列研究，平均随访3.7年。设置三个社区：东波士顿，马萨诸塞州，纽黑文，康涅狄格州，和爱荷华州和华盛顿县，爱荷华州。受试者共有1486名男性和2630名女性，年龄在71岁及以上，同意抽血。在随访期间，447名男性和488名女性死亡。在两种性别中，随着白蛋白水平的降低，死亡率逐渐升高。在调整了年龄、种族、教育、慢性病和残疾状况后，低白蛋白血症与参考组相比，（即，白蛋白水平大于43 g/L的患者）（男性：相对风险[RR]，1.9; 95%置信区间[CI]，1.1至3.1;女性：RR，3.7; 95% CI，2.5至5.5）。在白蛋白水平在通常认为正常范围（35 g/L至50 g/L）的患者中，从最高正常组到最低正常组，死亡风险呈分级增加。对于女性，在考虑基线后第一年和1年或更长时间内发生的死亡的单独分析中，结果相似，而对于男性，1年后这种关系下降。较低的白蛋白水平与所有死亡原因类别的死亡风险升高相关。根据白蛋白水平和残疾状态对参与者进行特征分析的15级指标表明，死亡率随着白蛋白水平的降低和残疾水平的增加而增加。结论：血清白蛋白水平是老年人全因死亡的独立危险因素。白蛋白和残疾的综合指标揭示了死亡风险的强烈梯度，可以作为一个简单但有用的脆弱指数，可以识别出一个高风险的老年男性和女性群体，他们可以成为预防和治疗工作的目标。
OBJECTIVES To study the relationship between serum albumin level and all-cause mortality in an elderly population and to evaluate the role of albumin level in combination with physical disability status in predicting mortality. DESIGN Cohort study with a mean follow-up of 3.7 years. SETTING Three communities: East Boston, Mass, New Haven, Conn, and Iowa and Washington counties, Iowa. SUBJECTS A total of 1486 men and 2630 women aged 71 years and older who consented to have blood drawn. RESULTS During follow-up, 447 men and 488 women died. In both sexes, there was a graded increase in mortality rate with decreasing albumin level. After adjusting for age, race, education, chronic conditions, and disability status, hypoalbuminemia (< 35 g/L) was associated with a significantly increased risk of mortality in comparison with the reference group (ie, those with albumin levels greater than 43 g/L) (men: relative risk [RR], 1.9; 95% confidence interval [CI], 1.1 to 3.1; women: RR, 3.7; 95% CI, 2.5 to 5.5). Among those with albumin levels in the range usually considered normal (35 g/L to 50 g/L), there was a graded increase in mortality risk from the highest normal to the lowest normal groups. For women, results were similar in separate analyses that considered deaths occurring during the first year and 1 year or more after baseline, while for men the relationship decreased after 1 year. Lower albumin level was associated with an elevated risk of mortality for all categories of causes of death. A 15-level measure that characterized participants according to albumin level and disability status demonstrated that mortality increased with decreasing albumin level and increasing disability level. CONCLUSIONS Serum albumin level is an independent risk factor for all-cause mortality in older persons. A combined measure of albumin and disability reveals a strong gradient in mortality risk and may serve as a simple but useful index of frailty that can identify a high-risk group of older men and women who could be targeted for preventive and treatment efforts.