Role of hypoalbuminemia and hypocholesterolemia as copredictors of mortality in acute renal failure

Background. Hypoalbuminemia(LA) and hypocholesterolemia (LC) have been reported to portend high mortality in both older patients and in patients with end-stage renal disease. Even though low levels have been reported in critically ill patients, they have not been clearly defined as predictors of mortality in acute renal failure (ARF). The impact of LA and LC on mortality in ARF is evaluated in this study. Methods. We conducted a computer-assisted three-year retrospective review of all cases of ne novo ARF seen at an inner city tertiary-cart facility. One hundred cases met the criteria for inclusion in the study. We employed both univariate and multivariate logistic regression models to estimate the relative risks (RR) and 95% confidence intervals (CI) of mortality associated with several variables. Results. Predictors associated with a high risk of death identified in this study include LC less than or equal to 150 mg/dl (less than or equal to 3.9 mmol/liter; RR, 7.4; CI, 2.7 to 20.3), LA less than or equal to 35 g/liter (RR, 5.0; CI, 1.9 to 13.2), sepsis (RR, 9.4; CI, 3.7 to 23.9), mechanical ventilation (RR, 10.8; CI, 2.8 to 41.0), oliguria (RR 17.0; CI, 6.2 to 46.6), and multisystem organ failure (RR 24.7; CI, 10.3 to 59.1), The overall gross mortality was 39%,but mortality among intensive care unit patients was 82%. Survival was 82% among patients with serum albumin > 35 g/liter versus 48% among those with serum albumin less than or equal to 35 g/liter (chi(2)? = 11.9, P = 0.0006). Similarly, survival was higher among patients with cholesterol > 150 mg/dl (> 3.9 mmol/liter) than those whose levels were less than or equal to 150 mg/dl (less than or equal to 3.9 mmol/liter; 85 vs. 44%,chi(2) = 17.3, P < 0.0001). Significant association between LA and LC was observed (R = 0.4, P < 0.0001). Age, gender, level of plasma creatinine, and underlying chronic medical conditions were not predictive of mortality. Conclusion. Survival in ARF is significantly altered by the levels of albumin and cholesterol. Because both LC and LA can be cytokine mediated, their presence in ARF should be considered ominous.