The prevalence and significance of hypoalbuminemia in non-variceal upper gastrointestinal bleeding.

Background/aims: Hypoalbuminemia occurs in a variety of disease states and is associated with an increased rate of complications during hospitalization, resulting in an increased length of stay. However, there are no data about hypoalbuminemia in patients with non-variceal upper gastrointestinal bleeding. The purpose of this study is to evaluate the prevalence of hypoalbuminemia in patients with non-variceal upper gastrointestinal bleeding and to examine its significance in relation to severity and outcome of bleeding.

Methodology: This is a retrospective analysis of data collected prospectively on consecutive patients admitted to the Emergency Department of Taichung Veterans General Hospital with upper GI bleeding, and variceal bleeding was excluded. Hypoalbuminemia is defined as serum albumin < 3.5 g/dL. The outcome assessments in the hypoalbuminemia and normal albumin groups were compared.

Results: There were three hundred and twenty-nine patients with non-variceal upper GI bleeding identified from July 2000 to January 2001. Two hundred and fifty were male, and 79 were female. Their ages ranged from 21 to 90 (64.60 +/- 14.84) years. Of these 329 patients eligible for the study, hypoalbuminemia was seen in 204 (62.0%). When compared to patients with normal serum albumin, the hypoalbuminemia group was older (66.81 +/- 13.45 vs. 60.98 +/- 16.29 years, P < 0.01), had more associated with underlying diseases (78.4% vs. 57.6%, P < 0.01), and had more leukocytosis (47.5% vs. 35.2%, P < 0.05), had lower hemoglobin (71.1% vs. 29.6% P < 0.01), and elevated BUN (85.3% vs. 72.8%, P < 0.01) at admission. In addition, these patients had longer hospital stay (6.82 +/- 9.45 vs. 2.38 +/- 3.48 days, P < 0.01), greater requirements of blood transfusion (5.76 +/- 7.43 vs. 1.38 +/- 2.20 units, P < 0.01), need of therapeutic endoscopy (41.7% vs. 16.0%, P < 0.01), with higher rebleeding rate (13.2% vs. 0%, P < 0.01), surgery rate (5.4% us. 0.8% P < 0.05), and mortality rate (9.3% vs. 0%, P < 0.01).

Conclusions: Hypoalbuminemia is common in patients with non-variceal upper GI bleeding, appears to reflect the severity of the bleeding episode, and is associated with a more complicated course.