What are the implications of low prealbumin (protein) levels?

From the Guidelines

Low prealbumin levels should be addressed by increasing protein intake to 1.2-1.5 g/kg of body weight daily, with a goal of achieving a prealbumin level of at least 30 mg/dL, as levels below this threshold are associated with increased mortality risk 1. To manage low prealbumin, consider the following:

• Increase protein intake through diet or supplements, focusing on lean meats, eggs, dairy, legumes, and protein supplements like whey protein
• Consider a multivitamin and mineral supplement to address potential micronutrient deficiencies
• If severely malnourished, consult a healthcare provider who may recommend oral nutritional supplements providing 300-400 calories per serving with 10-20g protein
• Treat underlying conditions like liver disease, chronic infections, or inflammatory disorders, as they can cause low prealbumin regardless of nutritional status Key points to note:
• Prealbumin has a short half-life of 2-3 days, making it sensitive to recent nutritional changes, so levels should improve within 1-2 weeks with proper nutrition 1
• Regular monitoring is recommended to track improvement, with normal levels typically ranging from 15-36 mg/dL
• Serum prealbumin is considered a valid measure of protein-energy nutritional status, and levels less than 30 mg/dL are associated with increased mortality risk 1

From the Research

Low Prealbumin Levels

• Low prealbumin levels have been associated with higher all-cause mortality rates in patients at nutrition risk 2
• Prealbumin levels can be used as a nutritional marker, but its clinical utility is still debatable 3
• Serum prealbumin concentrations have been proposed as a useful tool in the assessment of malnutrition in hospitalized patients 4

Association with Mortality

• A study found that low prealbumin levels (<0.17 g/L) were associated with higher 180-day mortality rates in patients at nutrition risk 2
• The hazard ratio for mortality at 180 days was 1.59 (95% CI 1.11-2.28) for patients with low prealbumin levels compared to those with normal prealbumin levels 2

Nutrition Support

• Individualized nutrition support was found to be effective in improving survival at 30 days in patients with low prealbumin levels, but the difference in mortality between patients receiving individualized nutrition support and usual-care nutrition was similar for patients with low and normal prealbumin levels 2
• Prealbumin dynamic assessment may be a reliable tool to estimate the effectiveness of nutrition support in the ICU, especially among high-risk patients 5

Analytical Methodologies

• Several analytical methodologies have been developed to measure prealbumin levels, which may help establish prealbumin as a useful biomarker in routine clinical practice 3
• The routine use of prealbumin in clinical practice remains debatable, but it can complement clinical history, anthropometric assessment, and physical examination to assess malnutrition with more certainty 3

Clinical Utility

• Prealbumin has been widely evaluated as a nutritional and prognostic marker, but its susceptibility to inflammation restricts its usage in critically ill patients according to current guidelines 5
• Prealbumin measured at ICU admission and its change during the first week serve as an accurate predictor of ICU mortality 5