{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:00:08Z","timestamp":1790830808029,"version":"4.1.0"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Patients with diabetic foot ulcers (DFUs) who undergo repeat wound culture and subsequent\n                      <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                      (PA) detection form a selected clinical trajectory. Early-admission serum albumin reflects inflammation, capillary permeability, hepatic synthesis, protein loss, hydration, and nutritional reserve; it is not a stand-alone measure of nutritional status. We examined its association with hospitalization burden conditional on this serial-culture trajectory.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective cohort included 408 hospitalized patients with DFU who had a PA-positive wound culture after an earlier non-PA culture during the same admission. Because cohort eligibility required continued hospitalization until repeat sampling and later PA detection, inference was conditional on a post-admission selection event susceptible to immortal-time and collider-selection bias. The culture sequence was an operational ascertainment pattern, not evidence of nosocomial acquisition, microbiological conversion, or invasive PA infection. The co-primary outcomes were length of stay (LOS) and institution-specific nominal hospital charges. Negative binomial and gamma log-link models estimated adjusted within-cohort associations. Exploratory prognostic analyses used bootstrap optimism correction and same-center temporal assessment (development, 2013\u20132016; assessment, 2017\u20132018).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 408 patients [261 men (64.0%)], median LOS was 14 days [interquartile range (IQR), 9\u201319] and median nominal hospital charges were CNY 18,708 (IQR, 12,532\u201327,979). Compared with albumin \u226535 g\/L, albumin 30 to &amp;lt;35 g\/L was associated with longer LOS [adjusted rate ratio (aRR), 1.24; 95% CI, 1.10\u20131.40] and higher charges [adjusted charge ratio (aCR), 1.28; 95% CI, 1.12\u20131.46]; corresponding estimates for albumin &amp;lt;30 g\/L were 1.52 (95% CI, 1.29\u20131.78) and 1.67 (95% CI, 1.40\u20131.99). Per 5-g\/L lower albumin, the aRR for LOS was 1.19 (95% CI, 1.14\u20131.25) and the aCR for charges was 1.22 (95% CI, 1.16\u20131.28). Baseline-only estimates changed by less than 3% on the log-ratio scale. Adding albumin increased the apparent area under the curve (AUC) from 0.679 to 0.758 (optimism-corrected, 0.643 to 0.729; \u0394AUC, 0.079; bootstrap 95% CI, 0.036\u20130.120). In the same-center temporal assessment sample (126 patients; 50 events), the AUC was 0.592 for the core model and 0.719 after albumin was added; corresponding Brier scores were 0.234 and 0.204, and calibration slopes were 0.625 and 0.994. These small-sample performance estimates were treated as descriptive. The median bootstrap-optimal albumin cutoff was 35 g\/L (95% bootstrap percentile interval, 33\u201337 g\/L).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Within this selected serial-culture cohort, lower early-admission albumin was associated with greater hospitalization burden and with numerically better exploratory prognostic performance in same-center analyses. These findings do not establish causality, transportability, a diagnosis of malnutrition, or a clinically actionable albumin threshold.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1918069","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T04:44:33Z","timestamp":1790829873000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Early-admission serum albumin and hospitalization burden in a selected serial-culture cohort of patients with diabetic foot ulcers and subsequent Pseudomonas aeruginosa detection: a retrospective cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Feifei","family":"Kan","sequence":"first","affiliation":[{"name":"Affiliated Hospital of Shandong Second Medical University","place":["Weifang, Shandong, 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