Objective To investigate the predictive value of serum albumin level in patients with severe sepsis .Methods One hundred and twenty cases of patients with severe sepsis admitted to Qilu Hospital ,Shandong University from April 2014 to October 2014 were prospectively enrolled .The serum albumin levels were measured and the laboratory and clinical data were collected at the onset of severe sepsis .Acute Physiology and Chronic Health Evaluation (APACHE ) Ⅱ score and Sequential Organ Failure Assessment (SOFA) score were calculated .Patients were grouped according to the prognosis by day 28 or stratified by albumin level . Prognostic factors were analyzed by multivariable Logistic regression .Results A total of 120 patients were enrolled with mean age of (57 .6 ± 18 .3) years ,among which 75 were male .The mean duration of hospitalization was (20 .1 ± 17 .8) days .The 28‐day mortality was 25 .8% (31/120) .The most common infection sources were respiratory tract (56 .7% ) ,abdominal/pelvis (19 .2% ) and bloodstream (9 .2% ) .Serum albumin level in survival group was significantly higher than that in death group ([32 .1 ± 6 .4] g/L vs [27 .5 ± 5 .5] g/L ,t=3 .562 ,P=0 .001) .Compared with survival group ,the patients in death group had higher APACHE Ⅱ and SOFA scores (22 .0 ± 9 .1 vs 13 .4 ± 7 .2;7 .1 ± 3 .7 vs 4 .3 ± 3 .5 ;t= —5 .372 and —3 .690 ,both P<0 .05) .Along with the decrease of serum albumin level ,the incidence of bloodstream infection ,solid tumor ,septic shock ,acute kidney injury and liver injury significantly increased .Patients with lower albumin level had significantly higher SOFA scores and 28‐day mortality (all P<0 .05) .Multivariable regression analysis showed that albumin level lower than 28 g/L and higher APACHE Ⅱ score were independent risk factors for mortality (OR=4 .156 ,95% CI:1 .198—14 .415 ;OR=1 .121 ,95% CI:1 .039—1 .210;both P<0 .05) .Conclusions A significantly lowered serum albumin level would increase the risk of mortality in patients with severe sepsis .The combination of albumin level and APAHCE Ⅱ score might be beneficial to evaluate the prognosis .

Objective:To evaluate the potential effects of serum lipid levels, appendicular skeletal muscle mass index (ASMI) and body mass index (BMI), together with its dynamic changes, on tumor progression in renal clear cell carcinoma patients, so as to inform body weight management.Methods:This prospective cohort study included a total of 100 patients with high-risk clear cell renal cell carcinoma. Serum lipid levels were detected, ASMI and BMI were measured using bioelectrical impedance analysis and the dynamic changes of BMI were tracked. The effects of BMI, ASMI and serum lipid levels on tumor progression within 2 years were explored.Results:Patients with normal BMI and low ASMI had 5.248 (95% CI: 1.946 to 14.153, P = 0.001) times higher risk of tumor progression than those who were overweight or obese. For every 0.1-unit increase in pre-operative HDL-C, the risk of tumor progression decreased by 0.771 (95% CI: 0.631 to 0.942, P = 0.011) times. Patients who experienced more than 5% decrease in BMI compared with baseline had 5.165 (95% CI: 1.735 to 15.370, P = 0.003) times the progression risk of patients whose BMI changed within ±5% from baseline. Conclusions:The advantage of obese clear cell carcinoma patients over normal-weight patients in tumor progression-free survival may be influenced by ASMI, pre-onset involuntary weight loss and lipid levels. Therefore, patient weight management should not merely focus on absolute BMI but tailor to individual characteristics, including cancer stage, body composition and metabolic status.