Serum prealbumin levels and their association with serum albumin, calcium, magnesium, and phosphorus concentrations

Abstract

Aims: Prealbumin is a specific and famous marker of nutritional conditions. The aim of our study was to investigate the relationship between serum prealbumin concentrations and serum albumin, magnesium, phosphorus and calcium levels. Methods: A total of 200 patients, 100 male and 100 female, aged 18-65 years, who applied to the Etlik City Hospital Internal Diseases Polyclinic between January 2023 and June 2023, were included in our study. The patients' prealbumin, albumin, calcium (Ca), magnesium (Mg), phosphorus (P), creatinine, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and complete blood count parameters (hemoglobin, white blood cell (WBC), platelet (PLT)) results were evaluated. Results: The median prealbumin of female subjects was 0.50 (0.1-1.0), while the median prealbumin of male subjects was 0.40 (0.1-1.0). There was no statistically significant difference between the groups (p>0.05). There is a direct positive between prealbumin concentration and calcium (r: 0.75; p<0.001), hemoglobin (r: 0.46; p<0.001), LDL (r: 0.50; p<0.001) and HDL (r: 0.63; p<0.001) concentrations and an negative correlation between magnesium (r: -0.16; p:0.02) and PLT (r: -0.31; p<0.001). Logistic regression analysis was performed to determine the independent variables affecting prealbumin concentration. The independent variables included in the model were HDL, LDL, body mass index (BMI), creatinine, WBC, phosphorus, age, magnesium, albumin, PLT, hemoglobin, and calcium. The Nagelgerke R2 square value of the model was 0.73 and the p value of the model in ANOVA analysis was calculated as <0.001. A regression formula for prealbumin concentrations was found: Prealbumin concentration = -0.609 + (Age x -0.002) + (BMI x 0.001) + (Ca x 0.63) + (Mg x -0.020) + (P x -0.002) + (Creatinine x 0.034) + (Hb x 0.016) + (WBC x -0.004) + (HDL x 0.001) + (LDL x 0.004). Conclusion: We think that the findings of our study will be useful in elucidating the relationship between serum prealbumin and albumin levels, which are important indicators of dietary protein intake, and serum mineral concentrations. Our study is the first manuscript to present a regression formula for prealbumin. The diagnostic and prognostic importance of prealbumin can be further elucidated by recruiting special and larger patient groups.

Keywords

• Prealbumin
• albumin
• calcium
• magnesium
• phosphorus

Serum prealbümin konsantrasyonları albümin, kalsiyum, magnezyum ve fosfor düzeyleri ile ilişkili olabilir mi?

Abstract

Amaç: Prealbümin, beslenme koşullarının spesifik ve ünlü bir belirtecidir. Çalışmamızın amacı serum prealbümin konsantrasyonları ile serum albümin, magnezyum, fosfor ve kalsiyum düzeyleri arasındaki ilişkiyi araştırmaktır. Yöntemler: Ocak 2023 - Haziran 2023 tarihleri arasında Etlik Şehir Hastanesi İç Hastalıkları Polikliniğine başvuran 18-65 yaş arası 100 erkek ve 100 kadın olmak üzere toplam 200 hasta çalışmamıza dahil edildi. Hastaların prealbümin, albümin, kalsiyum (Ca), magnezyum (Mg), fosfor (P), kreatinin, düşük yoğunluklu lipoprotein (LDL), yüksek yoğunluklu lipoprotein (HDL) ve tam kan sayımı parametrelerinin (hemoglobin (Hb), beyaz küre (WBC), trombosit (PLT)) sonuçları değerlendirildi. Bulgular: Kadın olguların medyan prealbümin değeri 0.50 (0.1-1.0) iken, erkek olguların medyan prealbümin değeri 0.40 (0.1-1.0) idi. Gruplar arasında istatistiksel olarak anlamlı bir fark bulunmadı (p>0.05). Prealbümin konsantrasyonu ile kalsiyum (r: 0.75; p<0.001), hemoglobin (r: 0.46; p<0.001), LDL (r: 0.50; p<0.001) ve HDL (r: 0.63; p<0.001) konsantrasyonları arasında doğrudan pozitif, magnezyum (r: -0.16; p:0.02) ve PLT (r: -0.31; p<0.001) arasında negatif bir korelasyon saptandı. Prealbümin konsantrasyonunu etkileyen bağımsız değişkenleri belirlemek için lojistik regresyon analizi yapıldı. Modele dahil edilen bağımsız değişkenler HDL, LDL, vücut kitle endeksi, kreatinin, WBC, fosfor, yaş, magnezyum, albümin, PLT, hemoglobin ve kalsiyumdu. Modelin Nagelgerke R2 kare değeri 0.73 ve ANOVA analizinde modelin p değeri <0.001 olarak hesaplandı. Prealbümin konsantrasyonları için bir regresyon formülü bulundu: Prealbümin konsantrasyonu = -0,609 + (Yaş x -0,002) + (VKİ x 0,001) + (Ca x 0,63) + (Mg x -0,020) + (P x -0,002) + (Kreatinin x 0,034) + (Hb x 0,016) + (WBC x -0,004) + (HDL x 0,001) + (LDL x 0,004). Sonuç: Çalışmamızın bulgularının, diyetle protein alımının önemli göstergeleri olan serum prealbümin ve albümin düzeyleri ile serum mineral konsantrasyonları arasındaki ilişkinin aydınlatılmasında faydalı olacağını düşünüyoruz. Çalışmamız prealbümin için bir regresyon formülü sunan ilk makaledir. Prealbüminin tanısal ve prognostik önemi, özel ve daha büyük hasta gruplarının araştırılmasıyla daha da aydınlatılabilir.

Keywords

• Prealbümin
• albümin
• kalsiyum
• magnezyum
• fosfor

References

1. Alemi M, Oliveira Â, Tavares SC, et al. Exploring the physiological role of transthyretin in glucose metabolism in the liver. Int J Mol Sci. 2021;22(11):6073. doi:10.3390/ijms22116073
2. Myron Johnson A, Merlini G, Sheldon J, Ichihara K. Scientific Division Committee on Plasma Proteins (C-PP), International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). Clinical indications for plasma protein assays: transthyretin (prealbumin) in inflammation and malnutrition. Clin Chem Lab Med. 2007;45(3):419-426. doi:10.1515/CCLM.2007.051
3. Huo RR, Liu HT, Deng ZJ, et al. Dose-response between serum prealbumin and all-cause mortality after hepatectomy in patients with hepatocellular carcinoma. Front Oncol. 2021;10:596691. doi:10.3389/fonc.2020.596691
4. Dellière S, Cynober L. Is transthyretin a good marker of nutritional status? Clin Nutr. 2017;36(2):364-370. doi:10.1016/j.clnu.2016.06.004
5. Sleep D. Albumin and its application in drug delivery. Expert Opin Drug Deliv. 2015;12(5):793-812. doi:10.1517/17425247.2015.993313
6. Ingenbleek Y, Bernstein LH. Plasma transthyretin as a biomarker of lean body mass and catabolic states. Adv Nutr. 2015;6(5):572-580. doi:10.3945/an.115.008508
7. Henze A, Homann T, Serteser M, et al. Post-translational modifications of transthyretin affect the triiodonine-binding potential. J Cell Mol Med. 2015;19(2):359-370. doi:10.1111/jcmm. 12446
8. Popov IA, Starodubtseva NL, Indeikina MI, et al. Mass spectrometric identification of posttranslational modification in transthyretin from human blood. Mol Biol. 2013;47:885-893. doi:10.1134/S0026893313060125

9. Karimi A, Shobeiri P, Kulasinghe A, Rezaei N. Novel systemic inflammation markers to predict COVID-19 prognosis. Front Immunol. 2021;12:741061. doi:10.3389/fimmu.2021.741061
10. Zuo P, Tong S, Yan Q, et al. Decreased prealbumin level is associated with increased risk for mortality in elderly hospitalized patients with COVID-19. Nutrition. 2020;78:110930. doi:10.1016/j.nut.2020.110930
11. Li Y, Liu X, Jiang Y, et al. Low preoperative prealbumin predicts the prevalence of complications following liver transplantation. BMC Gastroenterol. 2021;21(1):233. doi:10.1186/s12876-021-01818-1
12. Ni T, Wen Y, Wang Y, et al. Association between albumin or prealbumin levels at different stages and prognosis in severe acute pancreatitis: a 5-year retrospective study. Sci Rep. 2022;12(1):16792. doi:10.1038/s41598-022-21278-1
13. Wang Z, Zhang L, Wang J, et al. Prealbumin-to-globulin ratio can predict the chemotherapy outcomes and prognosis of patients with gastric cancer receiving first-line chemotherapy. J Immunol Res. 2020;2020:6813176. doi:10.1155/2020/6813176
14. Zu H, Wang H, Li C, Xue Y. Preoperative prealbumin levels on admission as an independent predictive factor in patients with gastric cancer. Medicine (Baltimore). 2020;99(11):e19196. doi:10.1097/MD.0000000000019196
15. Qiao W, Leng F, Liu T, et al. Prognostic value of prealbumin in liver cancer: a systematic review and meta-analysis. Nutr Cancer. 2020;72(6):909-916. doi:10.1080/01635581.2019.1661501
16. Fujii T, Yajima R, Takada T, et al. Serum albumin and prealbumin do not predict recurrence in patients with breast cancer. Anticancer Res. 2014;34(7):3775-3779.
17. Kopple JD, Greene T, Chumlea WC, et al. Relationship between nutritional status and the glomerular filtration rate: results from the MDRD study. Kidney Int. 2000;57(4):1688-1703. doi:10.1046/j.1523-1755.2000.00014.x
18. Don BR, Kaysen G. Serum albumin: relationship to inflammation and nutrition. Semin Dial. 2004;17(6):432-437. doi:10.1111/j.0894-0959.2004.17603.x
19. Beck FK, Rosenthal TC. Prealbumin: a marker for nutritional evaluation. Am Fam Physician. 2002;65(8):1575-1578.
20. Wang L, Yu H, Yang G, et al. Correlation between bone mineral density and serum trace element contents of elderly males in Beijing urban area. Int J Clin Exp Med. 2015;8(10):19250-19257.
21. Payne RB. Albumin-adjusted calcium and ionized calcium. Clin Chem. 2019;65(5):705-706. doi:10.1373/clinchem.2018.300905
22. Cantarutti C, Mimmi MC, Verona G, et al. Calcium binds to transthyretin with low affinity. Biomolecules. 2022;12(8):1066. doi:10.3390/biom12081066
23. Leidi M, Dellera F, Mariotti M, Maier JA. High magnesium inhibits human osteoblast differentiation in vitro. Magnes Res. 2011;24(1):1-6. doi:10.1684/mrh.2011.0271
24. WHO. A healthy lifestyle - WHO recommendations. 2023 Available at: https://www.who.int/europe/news-room/fact-sheets /item/a-healthy-lifestyle---who-recommendations
25. Liu F, Zhang X, Qi H, et al. Correlation of serum magnesium with cardiovascular risk factors in maintenance hemodialysis patients--a cross-sectional study. Magnes Res. 2013;26(3):100-108. doi:10.1684/mrh.2013.0344
26. López-González B, Molina-López J, Florea DI, Quintero-Osso B, Pérez de la Cruz A, Planells del Pozo EM. Association between magnesium-deficient status and anthropometric and clinical-nutritional parameters in posmenopausal women. Nutr Hosp. 2014;29(3):658-664. doi:10.3305/nh.2014.29.3.7198
27. Swaminathan R. Magnesium metabolism and its disorders. Clin Biochem Rev. 2003;24(2):47-66.
28. Chertow GM, Ackert K, Lew NL, Lazarus JM, Lowrie EG. Prealbumin is as important as albumin in the nutritional assessment of hemodialysis patients. Kidney Int. 2000;58(6):2512-2517. doi:10.1046/j.1523-1755.2000.00435.x
29. Li XS, Zhang JR, Zhao YL, et al. Reduced prealbumin is associated with bone mineral density in women with osteoporosis. Nutrition. 2017;33:338-342. doi:10.1016/j.nut.2016.08.002
30. Xiu S, Chhetri JK, Sun L, Mu Z, Wang L. Association of serum prealbumin with risk of osteoporosis in older adults with type 2 diabetes mellitus: a cross-sectional study. Ther Adv Chronic Dis. 2019;10:2040622319857361. doi:10.1177/2040622319857361
31. Handcox JE, Gutierrez-Naranjo JM, Salazar LM, Bullock TS, Griffin LP, Zelle BA. Nutrition and vitamin deficiencies are common in orthopaedic trauma patients. J Clin Med. 2021;10(21):5012. doi:10.3390/jcm10215012