Risk of venous thromboembolism and arterial events in patients with hypoalbuminemia: a comprehensive meta-analysis of more than 2 million patients
Emanuele Valeriani 1)2), Arianna Pannunzio 1), Ilaria Maria Palumbo 3), Simona Bartimoccia 4), Vittoria Cammisotto 3), Valentina Castellani 1)5), Angelo Porfidia 6), Pasquale Pignatelli 3 7), Francesco Violi 7)8)
1 – Department of General Surgery and Surgical Specialty, Sapienza University of Rome, Rome, Italy
2 – Department of Infectious Disease, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy
3 – Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
4 – Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
5 – Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
6 – Department of Medicine, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, Rome, Italy
7 – Mediterranea Cardiocentro, Via Orazio, Naples, Italy
8 – Sapienza University of Rome, Rome, Italy
Abstract
Background
Albumin has antiplatelet and anticoagulant functions. Hypoalbuminemia, as defined by serum values of <3.5 g/dL, is associated with arterial thrombosis; its impact on venous thromboembolism (VTE) is unclear.
Objectives
The objective of this meta-analysis is to assess the VTE risk in patients with hypoalbuminemia.
Methods
MEDLINE and EMBASE were searched up to January 2024 for observational studies and randomized trials reporting data of interest. Primary outcome was the risk of VTE, while secondary outcomes were myocardial infarction and stroke risk in patients with hypoalbuminemia versus those without hypoalbuminemia. The risk of bias was evaluated using Newcastle–Ottawa scale and Cochrane tool. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated in a random-effects model.
Results
Forty-three studies for a total of 2 531 091 patients (39 738 medical and 2 491 353 surgical) were included in primary analysis; 79.1% of the studies used 3.5 g/dL cut-off value for hypoalbuminemia definition. Follow-up duration was 30 days in 60.5% of studies. Patients with hypoalbuminemia had a higher risk of VTE (RR, 1.88; 95% CI, 1.66-2.13). RRs were similar in both medical (RR, 1.87; 95% CI, 1.53-2.27) and surgical patients (RR, 1.87; 95% CI, 1.61-2.16) and in patients with (RR, 1.86; 95% CI, 1.66-2.10) and without cancer (RR, 1.89; 95% CI, 1.47-2.44). Risk of myocardial infarction (RR, 1.88; 95% CI, 1.54-2.31) and stroke (RR, 1.77; 95% CI, 1.26-2.48) was higher in patients with hypoalbuminemia.
Conclusion
Hypoalbuminemia is a risk factor for VTE in both medical and surgical patients irrespective of cancer coexistence. Serum albumin analysis may represent a simple and cheap tool to identify patients at VTE risk.