Albumin and Survival in Extremity Metastatic Bone Disease: An Analysis of Two Independent Datasets

Abstract

Introduction

Numerous prognostication models have been developed to estimate survival in patients with extremity metastatic bone disease, but few include albumin despite albumin’s role in malnutrition and inflammation. The purpose of this study was to examine two independent datasets to determine the value for albumin in prognosticating survival in this population.

Materials and Methods

Extremity metastatic bone disease patients undergoing surgical management were identified from two independent populations. Population 1: Retrospective chart review at two tertiary care centers. Population 2: A large, national, North American multicenter surgical registry with 30-day follow-up. Bivariate and multivariate analyses were used to examine albumin’s value for prognostication at 1-, 3-, and 12-month after surgery.

Results

In Population 1, 1,090 patients were identified with 1-, 3-, and 12-month mortality rates of 95 (8.8%), 305 (28.9%), and 639 (62.0%), respectively. In Population 2, 1,675 patients were identified with one-month postoperative mortality rates of 148 (8.8%). In both populations, hypoalbuminemia was an independent prognostic factor for mortality at 30 days. In the institutional set, hypoalbuminemia was additionally associated with 3- and 12-month mortality.

Conclusions

Hypoalbuminemia is a marker for mortality in extremity metastatic bone disease. Further consideration of this marker could improve existing prognostication models in this population.

Level of Evidence

III

Ethical Review Committee Statement

For the institutional data, institutional review board approval was granted under protocol number: 2013P001994. The de-identified NSQIP data previously exempted from individual review by our institutional IRB.

Location

This research was performed at the Massachusetts General Hospital in Boston, MA.

Disclosure Statement

The authors declare no competing interests.

Additional information

Funding

No external funding was sought for this study.