• Khushbakht Arbab Combined Military Hospital (CMH) Quetta,
  • Hafsa Majid Aga Khan University
  • Lena Jafri Aga Khan University
  • Bushra Akram Dow University of Health Sciences
  • Ahmed Raheem Aga Khan University
  • Bushra Jamil Aga Khan University
  • Madiha Hashmi Aga Khan University
  • Aysha Habib Khan Aga Khan UNiversity


Background: Malnutrition in hospitalized patients, contributes to poor outcomes. Biomarker serum prealbumin, can prevent the complications by commencement of nutritional support to improve clinical outcomes. This study was designed to assess the association between low serum prealbumin level (<18 mg/dl), with length of stay and all cause intensive care unit mortality. Methods: This cross-sectional study was conducted from July 2016 to July 2017 at Aga Khan University Hospital Karachi Pakistan. All consecutive patients, aged between 18 to 70 years, admitted in medical or surgical intensive care unit were included. Demographic, clinical history and blood samples for analysing serum prealbumin were obtained on first day of admission. Patients were categorized into two groups based on their serum prealbumin level (taking <18 mg/dl as low). Results: A total of 139 patients were included in this study; 95 (68.3%) were male. Median (Q3-Q1) prealbumin level of 12.3 mg/dl (18.8–8.7) was observed with low prealbumin level (<18 mg/dl) in 100 (71.9%) patients. All-cause mortality was observed in 26 (26.0%) patients, mortality rate was significantly higher in patients with low prealbumin level (26.0% vs. 17.9%), p-value =0.31). Hospital and intensive care unit length of stay were statistically insignificantly different between the two groups with p-values of 0.27 and 0.44 respectively. Conclusion: We did not find association of low serum prealbumin with length of stay and mortality. Further research is warranted for the assessment of prealbumin as independent predictor of ICU mortality.Keywords: Prealbumin; length of stay; mortality; intensive care unit

Author Biographies

Khushbakht Arbab, Combined Military Hospital (CMH) Quetta,

Resident Trainee, Department of Pathology

Hafsa Majid, Aga Khan University

Senior Instructor, Department of Pathology & Laboratory Medicine

Lena Jafri, Aga Khan University

Assistant Professor, Department of Pathology & Laboratory Medicine

Bushra Akram, Dow University of Health Sciences

Medical Student

Ahmed Raheem, Aga Khan University

Biostatistician, Department of Pathology & Laboratory Medicine

Bushra Jamil, Aga Khan University

Professor, Department of Medicine

Madiha Hashmi, Aga Khan University

Assistant Professor, Department of Anaesthesiology

Aysha Habib Khan, Aga Khan UNiversity

Associate Professor & Consultant Chemical PathologistHead, Section of Clinical Chemistry


Soeters PB, Schols AM. Advances in understanding and assessing malnutrition. Curr Opin Clin Nutr Metab Care 2009;12(5):487–94.

Müller O, Krawinkel M. Malnutrition and health in developing countries. Can Med Assoc J 2005;173(3):279–86.

Chakravarty C, Hazarika B, Goswami L, Ramasubban S. Prevalence of malnutrition in a tertiary care hospital in India. Indian J Crit Care Med 2013;17(3):170–3.

Bharadwaj S, Ginoya S, Tandon P, Gohel TD, Guirguis J, Vallabh H, et al. Malnutrition: laboratory markers vs nutritional assessment. Gastroenterol Rep (Oxf) 2016;4(4):272–80.

Ingenbleek Y, Young VR. Significance of transthyretin in protein metabolism. Clin Chem Lab Med 2002;40(12):1281–91.

Winkler MF, Gerrior SA, Pomp A, Albina JE. Use of retinol-binding protein and prealbumin as indicators of the response to nutrition therapy. J Am Diet Assoc 1989;89(5):684–7.

Franco J, Formiga F, Trullas JC, Salamanca Bautista P, Conde A, Manzano L, et al. Impact of prealbumin on mortality and hospital readmission in patients with acute heart failure. Eur J Intern Med 2017;43:36–41.

Lee KH, Cho JH, Kwon O, Kim SU, Kim RH, Cho YW, et al. Low prealbumin levels are independently associated with higher mortality in patients on peritoneal dialysis. Kidney Res Clin Pract 2016;35(3):169–75.

Codullo V, Cereda E, Klersy C, Cavazzana I, Alpini C, Bonardi C, et al. Serum prealbumin is an independent predictor of mortality in systemic sclerosis outpatients. Rheumatology (Oxford) 2015;55(2):315–9.

Akella K, Akella S, Chendrasekhar A. Initial Prealbumin Level and Ability to Normalize Prealbumin Are Highly Predictive of Increased Mortality and Morbidity in Elderly Trauma Patients. Chest 2017;152(4):A346.

Yu PJ, Cassiere HA, Dellis SL, Manetta F, Kohn N, Hartman AR. Impact of preoperative prealbumin on outcomes after cardiac surgery. J Parenter Enteral Nutr 2015;39(7):870–4.

Cheng V, Inaba K, Haltmeier T, Gutierrez A, Siboni S, Benjamin E, et al. Serum transthyretin is a predictor of clinical outcomes in critically ill trauma patients. Surgery 2015;158(2):438–44.

Avram MM, Sreedhara R, Fein P, Oo KK, Chattopadhyay J, Mittman N. Survival on hemodialysis and peritoneal dialysis over 12 years with emphasis on nutritional parameters. Am J Kidney Dis 2001;37(1 Suppl 2):S77–80.

Yang HT, Yim H, Cho YS, Kim D, Hur J, Kim JH, et al. Prediction of clinical outcomes for massively-burned patients via serum transthyretin levels in the early postburn period. J Trauma Acute Care Surg 2012;72(4):999–1005.

Devakonda A, George L, Raoof S, Esan A, Saleh A, Bernstein LH. Transthyretin as a marker to predict outcome in critically ill patients. Clin Biochem 2008;41(14-15):1126–30.