{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T20:49:15Z","timestamp":1782334155909,"version":"3.54.5"},"reference-count":39,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: With a half-life of 18\u201320 days, rapid declines in plasma albumin (PA) levels may reflect increased vascular loss of PA, e.g., as seen with inflammatory insults. Methods: Our study included 11,562 adult patients with first-time bloodstream infection (BSI) in a geographically well-defined Danish region between 2007 and 2016, all with \u22652 PA specimens during BSI admission and discharged alive from the hospital. We assessed mortality 1\u201330, 31\u201390, 91\u2013365, and &gt;365 days after discharge. Predictors were the BSI admission\u2019s first or last PA specimen\u2019s level, grouped into &lt;25, 25\u201334, and \u226535 g\/L as well as combinations of these (reflecting changes [none, increase, or decrease]). We applied Cox\u2019s regression analyses for a baseline model with age, sex, comorbidity, and BSI microorganisms as well as the baseline model with amendments of the first, last, or change in the PA levels. We further computed areas under the ROC curves (AUROCs) to assess how much the PA covariates changed AUROCs for the baseline model. Results: The last PA group and the changes between the first and the last PA group were the strongest predictors, with little differences between these. Lower PA level groups predicted higher mortality, especially up to 90 days. For 1\u201330 day mortality, the hazard ratio was 3.69 for the last PA group of &lt;25 g\/L and 0.31 for \u226535 g\/L (reference: 25\u201334 g\/L). AUROCs for the baseline model were 0.72 for the 1\u201330 and 0.73 for the 31\u201390-day mortality whereas the amendment of the PA changes increased these areas to 0.79 and 0.76, respectively. Higher AUROCs (range 0.83\u20130.90) were seen in non-comorbid patients, in patients aged &lt;65 years, and in the lower quartile of days between the first and the last PA specimen. Conclusions: The BSI admission\u2019s last PA specimen was a strong mortality predictor, especially up to 90 days. Higher AUROCs were found in younger, non-comorbid patients, and in patients with higher velocity of the PA changes. These results corroborate that hypoalbuminemia is mainly a marker of acute events.<\/jats:p>","DOI":"10.3390\/jcm15114329","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T13:46:48Z","timestamp":1780494408000},"page":"4329","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Plasma Albumin Changes During Admission for Bloodstream Infection as Prognostic Predictors After Discharge\u2014A Population-Based Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5611-2031","authenticated-orcid":false,"given":"Kim Oren","family":"Gradel","sequence":"first","affiliation":[{"name":"Center for Clinical Epidemiology, Odense University Hospital, 5000 Odense, Denmark"},{"name":"Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1497-6309","authenticated-orcid":false,"given":"Ram Benny","family":"Dessau","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, Sj\u00e6llands Universitets Hospital, 4000 Slagelse, Denmark"},{"name":"Institute for Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5547-5498","authenticated-orcid":false,"given":"Jens Kj\u00f8lseth","family":"M\u00f8ller","sequence":"additional","affiliation":[{"name":"Institute for Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark"},{"name":"Department of Clinical Microbiology, Vejle Hospital, University Hospital of Southern Denmark, 7100 Vejle, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7780-7131","authenticated-orcid":false,"given":"Stig L\u00f8nberg","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Odense University Hospital, 5000 Odense, Denmark"},{"name":"Research Unit of Infectious Diseases, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4966-8453","authenticated-orcid":false,"given":"John Eugenio","family":"Coia","sequence":"additional","affiliation":[{"name":"Institute for Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"P\u00f3voa","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology, Odense University Hospital, 5000 Odense, Denmark"},{"name":"Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark"},{"name":"Department of Intensive Care, Hospital de S\u00e3o Francisco Xavier, Unidade Local de Sa\u00fade de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-028 Lisbon, Portugal"},{"name":"NOVA Medical School, Nova University of Lisbon, 1600-560 Lisbon, Portugal"},{"name":"D\u2019Or Institute for Research and Education (IDOR), Rio de Janeiro 22281-100, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1097\/01.SLA.0000055547.93484.87","article-title":"Hypoalbuminemia in acute illness: Is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials","volume":"237","author":"Vincent","year":"2003","journal-title":"Ann. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S193","DOI":"10.1007\/s11739-012-0802-0","article-title":"Hypoalbuminemia","volume":"7","author":"Gatta","year":"2012","journal-title":"Intern. Emerg. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1002\/jpen.1451","article-title":"Hypoalbuminemia: Pathogenesis and Clinical Significance","volume":"43","author":"Soeters","year":"2019","journal-title":"J. Parenter. Enter. Nutr."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Wiedermann, C.J. (2021). Hypoalbuminemia as Surrogate and Culprit of Infections. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22094496"},{"key":"ref_5","unstructured":"Gounden, V., Vashisht, R., and Jialal, I. (2018). Hypoalbuminemia, StatPearls."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/j.clnu.2024.02.018","article-title":"The clinical significance of hypoalbuminaemia","volume":"43","author":"Allison","year":"2024","journal-title":"Clin. Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"8743187","DOI":"10.1155\/2016\/8743187","article-title":"Postoperative Albumin Drop Is a Marker for Surgical Stress and a Predictor for Clinical Outcome: A Pilot Study","volume":"2016","author":"Hubner","year":"2016","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1016\/j.ijbiomac.2021.06.140","article-title":"Serum albumin levels and inflammation","volume":"184","author":"Sheinenzon","year":"2021","journal-title":"Int. J. Biol. Macromol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Gradel, K.O., P\u00f3voa, P., Garvik, O.S., Vinholt, P.J., Nielsen, S.L., Jensen, T.G., Chen, M., Dessau, R.B., M\u00f8ller, J.K., and Coia, J.E. (2020). Longitudinal trajectory patterns of plasma albumin and C-reactive protein levels around diagnosis, relapse, bacteraemia, and death of acute myeloid leukaemia patients. BMC Cancer, 20.","DOI":"10.1186\/s12885-020-06754-z"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1220","DOI":"10.1177\/000313481708301123","article-title":"Hypoalbuminemia and Clinical Outcomes: What is the Mechanism behind the Relationship?","volume":"83","author":"Kim","year":"2017","journal-title":"Am. Surg."},{"key":"ref_11","first-page":"454","article-title":"Serum Albumin Levels as a Predictor of Mortality in Patients with Sepsis: A Multicenter Study","volume":"24","author":"Frenkel","year":"2022","journal-title":"Isr. Med. Assoc. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1016\/j.ejim.2013.08.004","article-title":"Clinical characteristics and prognostic significance of serum albumin changes in an internal medicine ward","volume":"24","author":"Barchel","year":"2013","journal-title":"Eur. J. Intern. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1128\/CMR.00002-14","article-title":"Population-Based Epidemiology and Microbiology of Community-Onset Bloodstream Infections","volume":"27","author":"Laupland","year":"2014","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e74","DOI":"10.1017\/S0950268824000645","article-title":"Comparative epidemiology of bacteraemia in two ageing populations: Singapore and Denmark","volume":"152","author":"Sim","year":"2024","journal-title":"Epidemiol. Infect."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.jinf.2014.08.012","article-title":"Bacteremia is associated with excess long-term mortality: A 12-year population-based cohort study","volume":"70","author":"Nielsen","year":"2015","journal-title":"J. Infect."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1001\/jama.1995.03530100047033","article-title":"Long-term survival following bacteremia or fungemia","volume":"274","author":"Leibovici","year":"1995","journal-title":"JAMA"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"563","DOI":"10.2147\/CLEP.S179083","article-title":"The Danish health care system and epidemiological research: From health care contacts to database records","volume":"11","author":"Schmidt","year":"2019","journal-title":"Clin. Epidemiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1007\/s10654-014-9930-3","article-title":"The Danish Civil Registration System as a tool in epidemiology","volume":"29","author":"Schmidt","year":"2014","journal-title":"Eur. J. Epidemiol."},{"key":"ref_19","first-page":"119","article-title":"A microcomputer-assisted bacteriology reporting and information system","volume":"92","year":"1984","journal-title":"Acta Pathol. Microbiol. Immunol. Scand. B"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.3201\/eid1009.030978","article-title":"Computer algorithms to detect bloodstream infections","volume":"10","author":"Trick","year":"2004","journal-title":"Emerg. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.ajic.2008.03.002","article-title":"CDC\/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting","volume":"36","author":"Horan","year":"2008","journal-title":"Am. J. Infect. Control"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"449","DOI":"10.2147\/CLEP.S91125","article-title":"The Danish National Patient Registry: A review of content, data quality, and research potential","volume":"7","author":"Schmidt","year":"2015","journal-title":"Clin. Epidemiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"791","DOI":"10.7326\/0003-4819-137-10-200211190-00007","article-title":"Health care\u2013associated bloodstream infections in adults: A reason to change the accepted definition of community-acquired infections","volume":"137","author":"Friedman","year":"2002","journal-title":"Ann. Intern. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. Chronic Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1177\/1536867X1001000303","article-title":"Comparing the predictive power of survival models using Harrell\u2019s c or Somer\u2019s D","volume":"10","author":"Newson","year":"2010","journal-title":"Stata J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1148\/radiology.148.3.6878708","article-title":"A method of comparing the areas under receiver operating characteristic curves derived from the same cases","volume":"148","author":"Hanley","year":"1983","journal-title":"Radiology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1002\/0471722146.ch5","article-title":"Assessing the fit of the model","volume":"Volume 1","author":"Hosmer","year":"2000","journal-title":"Applied Logistic Regression"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1016\/S0895-4356(97)00015-2","article-title":"Association of serum albumin and mortality risk","volume":"50","author":"Goldwasser","year":"1997","journal-title":"J. Clin. Epidemiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.maturitas.2015.02.009","article-title":"Serum albumin and health in older people: Review and meta analysis","volume":"81","author":"Cabrerizo","year":"2015","journal-title":"Maturitas"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1186\/s40001-025-02925-5","article-title":"Dynamic association of serum albumin changes with inflammation, nutritional status and clinical outcomes: A secondary analysis of a large prospective observational cohort study","volume":"30","author":"Li","year":"2025","journal-title":"Eur. J. Med. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"S56","DOI":"10.2215\/CJN.03090509","article-title":"Biochemistry and biomarkers of inflamed patients: Why look, what to assess","volume":"4","author":"Kaysen","year":"2009","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1017\/S0950268818000274","article-title":"Hypoalbuminaemia as a marker of trans-capillary leakage in community-acquired bacteraemia patients","volume":"146","author":"Gradel","year":"2018","journal-title":"Epidemiol. Infect."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1111\/j.1469-0691.2011.03587.x","article-title":"Risk factors for recurrence and death after bacteraemia: A population-based study","volume":"17","author":"Jensen","year":"2011","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Magnussen, B., Gradel, K.O., Jensen, T.G., Kolmos, H.J., Pedersen, C., Vinholt, P.J., and Lassen, A.T. (2016). Association between hypoalbuminaemia and mortality in patients with community-acquired bacteraemia is primarily related to acute disorders. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0160466"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1111\/j.1365-2044.1996.tb07883.x","article-title":"The prognostic value of serial measurements of serum albumin concentration in patients admitted to an intensive care unit","volume":"51","author":"McCluskey","year":"1996","journal-title":"Anaesthesia"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.jinf.2009.12.007","article-title":"Recurrent bacteraemia: A 10-year regional population-based study of clinical and microbiological risk factors","volume":"60","author":"Jensen","year":"2010","journal-title":"J. Infect."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1007\/s10096-025-05347-7","article-title":"Predictors of 30-day readmission in patients with bloodstream infection: A population-based cohort study","volume":"45","author":"Gradel","year":"2025","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/j.jhep.2014.04.012","article-title":"Human serum albumin, systemic inflammation, and cirrhosis","volume":"61","author":"Arroyo","year":"2014","journal-title":"J. Hepatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1053\/j.jrn.2013.01.001","article-title":"Etiology of the protein-energy wasting syndrome in chronic kidney disease: A consensus statement from the International Society of Renal Nutrition and Metabolism (ISRNM)","volume":"23","author":"Carrero","year":"2013","journal-title":"J. Ren. Nutr."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4329\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T14:16:44Z","timestamp":1780496204000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4329"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,3]]},"references-count":39,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15114329"],"URL":"https:\/\/doi.org\/10.3390\/jcm15114329","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,3]]}}}