Prealbumin and C-reactive protein levels at hospital admission as predictors of rehospitalization or death in elderly frail patients

Background and aims – Both malnutrition and inflammation can adversely influence prognosis in various diseases, but their specific role in frail multiple-disease elderly inpatients is still poorly understood. Our aim was therefore to establish the prognostic value of nutritional and inflammatory markers at hospital admission in such patients. Methods – We consecutively evaluated 400 frail elderly multiple-disease subjects (179 M, 221 F, mean age 79 ± 10 years) admitted to Critical Subacute Care Unit of Parma University Hospital, Italy. A blood sample for C-reactive protein (CRP) and prealbumin assessment was collected at admission. The values of other routine blood tests, such as hemoglobin, iron, cholesterol, ferritin, were recorded, along with the comorbidities of each patient. After a two-month follow-up period from hospital discharge, every patient’s caregiver was telephonically interviewed to assess mortality or hospital readmission, and a survival analysis (Kaplan Meyer method) and Cox proportional models (adjusted hazard ratio) were performed to assess their relationship with CRP, prealbumin and CRP-to-prealbumin ratio. Results – Mean prealbumin levels at admission were 17,3±7,7 mg/dl. Median CRP levels were 24,2 mg/L (interquartile range: 8,7-51,8 mg/L). CRP-to-prealbumin ratio median was 1,40 (interquartile range: 0,43-4,14). 49% of the patients died or were readmitted to hospital within the 2-mo follow up. After adjusting for age and sex, low prealbumin levels (HR 0.973[0.948-1.000], p=0.049), high levels of CRP (HR 1.007[1.003-1.012], p=0.02) and CRP-to-prealbumin ratio (HR 1.050[1.014-1.088], p=0.007) were significant predictors of adverse outcome. After adjustment for gender, weight, hemoglobin, serum cholesterol, ferritin, iron, diagnosis of dementia and cancer, the only independent predictors of death were CRP levels and CRP-to-prealbimin ratio. The risk of hospital readmission or death at 2 months was significantly higher in the highest CRP quartile (>70 mg/L), HR 2.310, CI95% 1.233-4.329, p=0.009. Conclusions - C-reactive protein and CRP-to-prealbumin ratio are significant predictors of death or hospital readmission within 2 months in older patients admitted to hospital.