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Gremese E, Bruno D, Varriano V, Perniola S, Petricca L, Ferraccioli G. Serum Albumin Levels: A Biomarker to Be Repurposed in Different Disease Settings in Clinical Practice. J Clin Med 2023; 12:6017. [PMID: 37762957 PMCID: PMC10532125 DOI: 10.3390/jcm12186017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/10/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Serum albumin (ALB), one of the most important proteins in human physiology, has the main functions of maintaining plasma oncotic pressure and plasma volume, transporting hormones, vitamins, oligominerals and drugs, and exerting a powerful antioxidant-anti-inflammatory role. Its prognostic value in liver and malabsorption syndromes is well known. In this narrative review, an analysis of the most important studies evaluating the prognostic significance of low serum ALB levels in hospitalized patients was performed. Specifically, the risk in emergency medicine, cardiovascular diseases, Coronavirus Disease 19 (COVID-19) infection, nephrology, oncology, and autoimmune rheumatic diseases has been examined to fully explore its clinical value. ALB is a negative acute-phase reactant and the reduction in its serum levels represents a threatening parameter for long-term survival in several clinical settings, and a strong biomarker for a poor prognosis in most diseases. Therefore, clinicians should consider serum ALB as a valuable tool to assess the efficacy of specific therapies, both in hospitalized patients and in chronic follow-up.
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Affiliation(s)
- Elisa Gremese
- Clinical Immunology Unit, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Catholic University of the Sacred Heart, 00168 Roma, Italy
- Immunology Core Facility, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Roma, Italy
| | - Dario Bruno
- Clinical Immunology Unit, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168, Roma, Italy; (D.B.); (V.V.); (S.P.)
| | - Valentina Varriano
- Clinical Immunology Unit, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168, Roma, Italy; (D.B.); (V.V.); (S.P.)
| | - Simone Perniola
- Immunology Core Facility, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Roma, Italy
- Clinical Immunology Unit, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168, Roma, Italy; (D.B.); (V.V.); (S.P.)
| | - Luca Petricca
- Rheumatology Division, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Roma, Italy;
| | - Gianfranco Ferraccioli
- Department of Internal Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy;
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Arif Z, Tarannum A, Arfat MY, Arif B, Shahab S, Arif M, Nelofar K, Badar A, Islam SN, Zaman A, Ahmad S, Iqubal MA, Gupta A, Aggarwal A, Alam K. Impact of endogenous stress on albumin structure in systemic lupus erythematosus (SLE) patients. Int J Biol Macromol 2020; 151:891-900. [PMID: 32014478 DOI: 10.1016/j.ijbiomac.2020.01.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 01/25/2020] [Accepted: 01/30/2020] [Indexed: 10/25/2022]
Abstract
Systemic lupus erythematosus (SLE) is an inflammatory, autoimmune disorder of unknown etiology. The inflammatory stress in SLE patients may modify macromolecules and produce structural/functional abnormalities. The present study is aimed at examining the consequences of stresses on the structure of albumin in SLE patients. Albumin was isolated from the sera of SLE/healthy subjects. Multiple physicochemical techniques were used to elucidate, structure of albumin. Advanced glycation end products in SLE patients' albumin were identified by the AGE specific fluorescence. Quenching of tryptophan, tyrosine fluorescence and surface protein hydrophobicity was observed in SLE patients' albumin. Protein-bound carbonyls were elevated while free thiol, lysine, arginine, and alpha helicity was found to be decreased in SLE albumin. Furthermore, changes in the secondary structure of SLE albumin were observed as shift in the position of amide I/II bands. Functionality of SLE albumin was also compromised as its cobalt-binding ability was substantially declined. Adduction of moieties was detected by dynamic light scattering (DLS) and confirmed by matrix assisted laser desorption/ionization. DLS, thioflavin T and transmission electron microscopy results confirmed aggregates in SLE patients' albumin. This study may be helpful in understanding the role of modified albumin in the cofounding pathologies associated with SLE.
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Affiliation(s)
- Zarina Arif
- Department of Biochemistry, Faculty of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh 202002, India.
| | - Akhlas Tarannum
- Department of Biochemistry, Faculty of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh 202002, India
| | - Mir Yasir Arfat
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Binish Arif
- Department of Clinical Biochemistry, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India
| | - Sana Shahab
- Department of Business and Administration, College of Business and Administration, Princess Norah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Maryam Arif
- Department of Biochemistry, Faculty of Life Science, Aligarh Muslim University, Aligarh 202002, India
| | - Km Nelofar
- Department of Biochemistry, Faculty of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh 202002, India
| | - Asim Badar
- Department of Biochemistry, Faculty of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh 202002, India
| | - Shireen Naaz Islam
- Department of Biochemistry, Faculty of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh 202002, India
| | - Asif Zaman
- Department of Biochemistry, Faculty of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh 202002, India
| | - Shafeeque Ahmad
- Department of Biochemistry, Al-Falah School of Medical Science and Research Centre, Al-Falah University, Dhauj, Faridabad 121004, Haryana, India
| | - Mohammad Arif Iqubal
- Department of Biochemistry, Faculty of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh 202002, India
| | - Akankcha Gupta
- Department of Biochemistry, Faculty of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh 202002, India
| | - Amita Aggarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Khursheed Alam
- Department of Biochemistry, Faculty of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh 202002, India
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Kwon OC, Lee JS, Ghang B, Kim YG, Lee CK, Yoo B, Hong S. Predicting eventual development of lupus nephritis at the time of diagnosis of systemic lupus erythematosus. Semin Arthritis Rheum 2018; 48:462-466. [DOI: 10.1016/j.semarthrit.2018.02.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/12/2018] [Accepted: 02/20/2018] [Indexed: 11/30/2022]
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4
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Matusik PS, Matusik PT, Stein PK. Heart rate variability in patients with systemic lupus erythematosus: a systematic review and methodological considerations. Lupus 2018; 27:1225-1239. [PMID: 29697012 DOI: 10.1177/0961203318771502] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aim The aim of this review was to summarize current knowledge about the scientific findings and potential clinical utility of heart rate variability measures in patients with systemic lupus erythematosus. Methods PubMed, Embase and Scopus databases were searched for the terms associated with systemic lupus erythematosus and heart rate variability, including controlled vocabulary, when appropriate. Articles published in English and available in full text were considered. Finally, 11 publications were selected, according to the systematic review protocol and were analyzed. Results In general, heart rate variability, measured in the time and frequency domains, was reported to be decreased in patients with systemic lupus erythematosus compared with controls. In some systemic lupus erythematosus studies, heart rate variability was found to correlate with inflammatory markers and albumin levels. A novel heart rate variability measure, heart rate turbulence onset, was shown to be increased, while heart rate turbulence slope was decreased in systemic lupus erythematosus patients. Reports of associations of changes in heart rate variability parameters with increasing systemic lupus erythematosus activity were inconsistent, showing decreasing heart rate variability or no relationship. However, the low/high frequency ratio was, in some studies, reported to increase with increasing disease activity or to be inversely correlated with albumin levels. Conclusions Patients with systemic lupus erythematosus have abnormal heart rate variability, which reflects cardiac autonomic dysfunction and may be related to inflammatory cytokines but not necessarily to disease activity. Thus measurement of heart rate variability could be a useful clinical tool for monitoring autonomic dysfunction in systemic lupus erythematosus, and may potentially provide prognostic information.
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Affiliation(s)
- P S Matusik
- 1 Department of Radiology, University Hospital, Kraków, Poland.,2 Jagiellonian University Medical College, Kraków, Poland
| | - P T Matusik
- 3 Department of Electrocardiology, The John Paul II Hospital, Kraków, Poland.,4 Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - P K Stein
- 5 Department of Medicine, Washington University School of Medicine, USA
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5
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Poliwczak AR, Waszczykowska E, Dziankowska-Bartkowiak B, Koziróg M, Dworniak K. The use of heart rate turbulence and heart rate variability in the assessment of autonomic regulation and circadian rhythm in patients with systemic lupus erythematosus without apparent heart disease. Lupus 2017; 27:436-444. [PMID: 28795655 DOI: 10.1177/0961203317725590] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Systemic lupus erythematosus is a progressive autoimmune disease. There are reports suggesting that patients even without overt signs of cardiovascular complications have impaired autonomic function. The aim of this study was to assess autonomic function using heart rate turbulence and heart rate variability parameters indicated in 24-hour ECG Holter monitoring. Methods Twenty-six women with systemic lupus erythematosus and 30 healthy women were included. Twenty-four hour ambulatory ECG-Holter was performed in home conditions. The basic parameters of heart rate turbulence and heart rate variability were calculated. The analyses were performed for the entire day and separately for daytime activity and night time rest. Results There were no statistically significant differences in the basic anthropometric parameters. The mean duration of disease was 11.52 ± 7.42. There was a statistically significant higher turbulence onset (To) value in patients with systemic lupus erythematosus, median To = -0.17% (minimum -1.47, maximum 3.0) versus To = -1.36% (minimum -4.53, maximum -0.41), P < 0.001. There were no such differences for turbulence slope (Ts). In the 24-hour analysis almost all heart rate variability parameters were significantly lower in the systemic lupus erythematosus group than in the healthy controls, including SDANN and r-MSSD and p50NN. Concerning the morning activity and night resting periods, the results were similar as for the whole day. In the control group, higher values in morning activity were noted for parameters that characterise sympathetic activity, especially SDANN, and were significantly lower for parasympathetic parameters, including r-MSSD and p50NN, which prevailed at night. There were no statistically significant changes for systemic lupus erythematosus patients for p50NN and low and very low frequency. There was a positive correlation between disease duration and SDNN, R = 0.417; P < 0.05 and SDANN, R = 0.464; P < 0.05, a negative correlation between low/high frequency ratio and r-MSSD, R = -0.454; P < 0.05; p50NN, R = -0.435; P < 0.05 and high frequency, R = -0.478; P < 0.05. In contrast, there was no statistically significant correlation between heart rate turbulence and other variables evaluated, including disease duration and the type of autoantibodies. CONCLUSION Our study confirms the presence of autonomic disorders with respect to both heart rate variability and heart rate turbulence parameters and the presence of diurnal disturbances of sympathetic-parasympathetic balance. Further studies are required.
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Affiliation(s)
- A R Poliwczak
- 1 Department of Internal Diseases and Clinical Pharmacology, 37808 Medical University of Lodz , Lodz, Poland
| | - E Waszczykowska
- 2 Department of Dermatology and Venereology, 37808 Medical University of Lodz , Lodz, Poland
| | | | - M Koziróg
- 3 Department of Internal Medicine and Cardiologic Rehabilitation, 37808 Medical University of Lodz , Lodz, Poland
| | - K Dworniak
- 4 Department of Internal Medicine and Geriatrics, Regional Specialized Hospital in Zgierz, Zgierz, Poland
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Bienias P, Ciurzyński M, Chrzanowska A, Dudzik-Niewiadomska I, Irzyk K, Oleszek K, Kalińska-Bienias A, Kisiel B, Tłustochowicz W, Pruszczyk P. Attenuated post-exercise heart rate recovery in patients with systemic lupus erythematosus: the role of disease severity and beta-blocker treatment. Lupus 2017. [DOI: 10.1177/0961203317716318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- P Bienias
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland
| | - M Ciurzyński
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland
| | - A Chrzanowska
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland
| | - I Dudzik-Niewiadomska
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland
| | - K Irzyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland
| | - K Oleszek
- Students' Scientific Association by Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland
| | - A Kalińska-Bienias
- Department of Dermatology and Immunodermatology, Medical University of Warsaw, Poland
| | - B Kisiel
- Department of Internal Diseases and Rheumatology, Military Institute of Medicine, Warsaw, Poland
| | - W Tłustochowicz
- Department of Internal Diseases and Rheumatology, Military Institute of Medicine, Warsaw, Poland
| | - P Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland
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Sasaki K, Haga M, Bao S, Sato H, Saiki Y, Maruyama R. The Cardiac Sympathetic Nerve Activity in the Elderly Is Attenuated in the Right Lateral Decubitus Position. Gerontol Geriatr Med 2017; 3:2333721417708071. [PMID: 28516131 PMCID: PMC5419066 DOI: 10.1177/2333721417708071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/29/2017] [Accepted: 04/03/2017] [Indexed: 01/01/2023] Open
Abstract
Objectives: The aim of this study was to evaluate the effect of the supine, left lateral decubitus, and right lateral decubitus positions on autonomic nervous activity in elderly adults by using spectral analysis of heart rate variability (HRV). Method: Forty-five adults aged 73.6 ± 5.7 years were enrolled. After lying in the supine position, all participants moved to the lateral decubitus positions in a random order and maintained the positions for 10 min, while electrocardiographic data were recorded to measure HRV. Results: The lowest heart rate continued for 10 min when participants were in the left lateral decubitus position compared with the other two positions (p < .001), while the HRV indexes remained unchanged. The low-frequency HRV to high-frequency HRV ratio (LF/HF) for the right lateral decubitus position was significantly lower than that for the other positions. Discussion: The right lateral decubitus position may attenuate sympathetic nerve activity in elderly adults.
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Affiliation(s)
| | - Mayu Haga
- Tohoku University School of Medicine, Sendai, Japan
| | - Sarina Bao
- Tohoku University School of Medicine, Sendai, Japan
| | - Haruka Sato
- Tohoku University School of Medicine, Sendai, Japan
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Sasaki K, Haga M, Endo Y, Fujiwara J, Maruyama R. Left Recumbent Position Decreases Heart Rate without Alterations in Cardiac Autonomic Nervous System Activity in Healthy Young Adults. TOHOKU J EXP MED 2017; 241:309-318. [PMID: 28442640 DOI: 10.1620/tjem.241.309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Some studies have reported that recumbent position may have advantages in patients with heart disease and in pregnancy. However, it remains controversial whether recumbent position affects autonomic nervous system activity and hemodynamics in healthy adults. The aim of this study was to evaluate alterations in heart rate variability (HRV) and hemodynamics in the supine, left recumbent and right recumbent positions in healthy young adults. A total of 80 participants aged 22.8 ± 3.1 years were enrolled in this observational study. Fifty-eight volunteers (29 men and 29 women) maintained the supine position followed by the left and right recumbent positions, while electrocardiographic data were recorded for spectral analysis of HRV to assess cardiac vagal nerve and sympathetic nerve activities. The heart rate (HR) was significantly lower in the left recumbent position than in the other positions. There were no statistically significant differences in HRV among the three positions. Considering the possibility that the echographic procedure affects autonomic nervous system (ANS) activity, the other 22 participants (11 men and 11 women) underwent an echographic evaluation of hemodynamics in the heart and inferior vena cava (IVC) across the three positions. Although a low HR was also observed, there were no statistically significant differences in the IVC or the heart blood volume between the supine and the left recumbent positions. A postural change to the left recumbent position does not affect the cardiac blood circulation or ANS activity, though it does decrease HR in healthy young adults. This finding indicates that the lower HR in the left recumbent position is not attributable to the ANS activity.
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Affiliation(s)
- Konosuke Sasaki
- Department of Health Sciences, Tohoku University Graduate School of Medicine
| | - Mayu Haga
- Department of Health Sciences, Tohoku University Graduate School of Medicine
| | - Yoichi Endo
- Division of Clinical Physiological Laboratory, Tohoku University Hospital
| | - Junko Fujiwara
- Division of Clinical Physiological Laboratory, Tohoku University Hospital
| | - Ryoko Maruyama
- Department of Health Sciences, Tohoku University Graduate School of Medicine
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Nunan D, Sandercock GRH, Brodie DA. A quantitative systematic review of normal values for short-term heart rate variability in healthy adults. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 33:1407-17. [PMID: 20663071 DOI: 10.1111/j.1540-8159.2010.02841.x] [Citation(s) in RCA: 444] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Heart rate variability (HRV) is a known risk factor for mortality in both healthy and patient populations. There are currently no normative data for short-term measures of HRV. A thorough review of short-term HRV data published since 1996 was therefore performed. Data from studies published after the 1996 Task Force report (i.e., between January 1997 and September 2008) and reporting short-term measures of HRV obtained in normally healthy individuals were collated and factors underlying discrepant values were identified. Forty-four studies met the pre-set inclusion criteria involving 21,438 participants. Values for short-term HRV measures from the literature were lower than Task Force norms. A degree of homogeneity for common measures of HRV in healthy adults was shown across studies. A number of studies demonstrate large interindividual variations (up to 260,000%), particularly for spectral measures. A number of methodological discrepancies underlined disparate values. These include a systematic failure within the literature (a) to recognize the importance of RR data recognition/editing procedures and (b) to question disparate HRV values observed in normally healthy individuals. A need for large-scale population studies and a review of the Task Force recommendations for short-term HRV that covers the full-age spectrum were identified. Data presented should be used to quantify reference ranges for short-term measures of HRV in healthy adult populations but should be undertaken with reference to methodological factors underlying disparate values. Recommendations for the measurement of HRV require updating to include current technologies.
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Affiliation(s)
- David Nunan
- Division of Public Health and Primary Health Care, University of Oxford, Oxford, UK.
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YIP JONATHAN, AGHDASSI ELAHEH, SU JIANDONG, LOU WENDY, REICH HEATHER, BARGMAN JOANNE, SCHOLEY JAMES, GLADMAN DAFNAD, UROWITZ MURRAYB, FORTIN PAULR. Serum Albumin as a Marker for Disease Activity in Patients with Systemic Lupus Erythematosus. J Rheumatol 2010; 37:1667-72. [DOI: 10.3899/jrheum.091028] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To determine whether serum albumin reflects disease activity in patients with systemic lupus erythematosus (SLE) with and without nephritis (LN, LNN), and whether serum albumin could be a surrogate marker of SLE disease activity overall. There is currently no clinical “gold standard” in the assessment of disease activity in SLE.Methods.Patients with ≥ 3 clinic visits within a maximum followup period of 10 years were selected from the University of Toronto Lupus Clinic database. Subjects were divided into 3 groups: LN-B, those with nephritis defined by histological findings on renal biopsies; LN-L, those with nephritis defined by laboratory abnormalities in the absence of biopsy; and LNN, those without nephritis. In a subanalysis, the renal groups were further stratified by proteinuria status. The associations of SLE-Disease Activity Index (SLEDAI-2K) with serum albumin and dsDNA were examined using the mixed model regression analysis.Results.A total of 1078 patients were studied: 89.1% female, 71.5% white, mean age 33.6 (SD 12.6) years, and with median baseline SLEDAI-2K of 8. Serum albumin was more significantly associated with SLEDAI in LN-B and LN-L. The association was also present but weaker in the LNN group. In all LN, the associations between serum albumin and SLEDAI-2K were stronger in those with proteinuria.Conclusion.In patients with SLE, higher SLEDAI was associated with lower serum albumin levels.
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