Hypoalbuminemia and Early Mortality After Lung Transplantation: A Cohort Study

Hypoalbuminemia predicts disability and mortality in patients with various illnesses and in the elderly. The association between serum albumin concentration at the time of listing for lung transplantation and the rate of death after lung transplantation is unknown. We examined 6808 adults who underwent lung transplantation in the United States between 2000 and 2008. We used Cox proportional hazard models and generalized additive models to examine multivariable‐adjusted associations between serum albumin and the rate of death after transplantation. The median follow‐up time was 2.7 years. Those with severe (0.5–2.9 g/dL) and mild hypoalbuminemia (3.0–3.6 g/dL) had posttransplant adjusted mortality rate ratios of 1.35 (95% CI: 1.12–1.62) and 1.15 (95% CI: 1.04–1.27), respectively. For each 0.5 g/dL decrease in serum albumin concentration the 1‐year and overall mortality rate ratios were 1.48 (95% CI: 1.21–1.81) and 1.26 (95% CI: 1.11–1.43), respectively. The association between hypoalbuminemia and posttransplant mortality was strongest in recipients with cystic fibrosis and interstitial lung disease. Hypoalbuminemia is an independent risk factor for death after lung transplantation.     

Coagulation studies in rheumatic heart disease

The clotting characteristics of pulmonary and systemic blood were studied in 10 patients with chronic rheumatic mitral valve disease complicated by atrial fibrillation and in seven patients with aortic valve disease in sinus rhythm. A haemostatic basis for the association of rheumatic mitral valve disease with thrombotic emboli was sought. Both groups of patients showed differences in platelet function between pulmonary and systemic arterial blood. In patients with mitral valve disease aggregation of platelets was significantly greater in pulmonary than in systemic arterial blood at rest; the converse was true during exercise. In aortic valve disease platelet aggregation was greater in systemic than in pulmonary arterial blood at all times. Only the patients with mitral valve disease showed changes in blood coagulation during passage through the lungs and left heart; there was a small but statistically significant shortening in partial thromboplastin time in systemic as compared with pulmonary arterial blood both at rest and during exercise. Similarly, the effects of exercise on the various haemostatic factors measured were largely confined to the patients with mitral valve disease; in these patients exercise stimulated an increase in factor VIII in pulmonary arterial blood and an increase in platelet adhesiveness and aggregability in left heart blood. These changes provide a basis for the suggestion that in patients with rheumatic mitral valve disease, unlike those with aortic valve disease, there is an increased thrombotic tendency in blood in the left heart which is particularly pronounced during exercise.     

Cholesterin und Wasserhaushalt

Ohne ZusammenfassungErscheint ausführlich in der Zeitschr f. d. ges. exp. Med.