Abstract

Objectives. A general body of evidence suggests that low serum albumin might be associated with increased risk of adverse cardiometabolic outcomes, but findings are divergent. We aimed to quantify associations of serum albumin with the risk of type 2 diabetes (T2D), cardiovascular disease (CVD), all-cause mortality, and other adverse outcomes using a systematic review and meta-analyses of published observational cohort studies. Design. MEDLINE, Embase, Web of Science, and manual search of relevant bibliographies were systematically searched to January 2020. Relative risks (RRs) with 95% confidence intervals (CIs) comparing top versus bottom thirds of serum albumin levels were pooled. Results. Fifty-four articles based on 48 unique observational cohort studies comprising of 1,492,237 participants were eligible. Multivariable adjusted RRs (95% CIs) comparing the top vs bottom third of serum albumin levels were: 1.03 (0.86–1.22) for T2D; 0.60 (0.53–0.67) for CVD; 0.74 (0.66–0.84) for coronary heart disease (CHD); 0.57 (0.36–0.91) for CHD death; 0.76 (0.65–0.87) for myocardial infarction; 0.66 (0.55–0.77) for all-cause mortality; 0.71 (0.61–0.83) for venous thromboembolism; 0.65 (0.48–0.88) for cancer mortality; and 0.62 (0.46–0.84) for fracture. Heterogeneity between contributing studies of T2D was partly explained by sample sizes of studies (p for meta-regression = .035). Conclusions. Elevated levels of serum albumin are associated with reduced risk of vascular outcomes, all-cause mortality, certain cancers, and fracture. Inconsistent findings for T2D may be attributed to selective reporting by studies. Further research is needed to assess any potential causal relevance to these findings and the role of serum albumin concentrations in disease prevention.

Systematic review registration: PROSPERO 2019: CRD42019125869

摘要

目标。一般的证据表明，血清白蛋白低可能与不良的心脏代谢结果的风险增加有关，但发现存在分歧。我们旨在通过对发表的观察性队列研究的系统评价和荟萃分析，量化血清白蛋白与2型糖尿病（T2D），心血管疾病（CVD），全因死亡率和其他不良结局的风险之间的关系。设计。到2020年1月，系统搜索了MEDLINE，Embase，Web of Science和相关书目的人工搜索。合并了95％置信区间（CI）的相对风险（RRs），用于比较血清白蛋白水平的顶部和底部三分之一。结果。根据48项独特的观察性队列研究（包括1,492,237名参与者）的54篇文章符合条件。比较血清白蛋白水平的顶部和底部三分之一的多变量调整RR（95％CI）为：T2D为1.03（0.86-1.22）；CVD为0.60（0.53-0.67）；冠心病（CHD）为0.74（0.66-0.84）；冠心病死亡0.57（0.36-0.91）；心肌梗塞为0.76（0.65-0.87）；全因死亡率为0.66（0.55-0.77）；静脉血栓栓塞为0.71（0.61-0.83）；癌症死亡率为0.65（0.48–0.88）；骨折时为0.62（0.46-0.84）。T2D贡献研究之间的异质性部分由研究的样本量来解释（meta回归的p = .035）。结论。血清白蛋白水平升高与血管结局，全因死亡率，某些癌症和骨折的风险降低有关。T2D的不一致发现可能归因于研究的选择性报告。需要进一步的研究来评估与这些发现有关的任何潜在因果关系，以及血清白蛋白浓度在疾病预防中的作用。

系统审查注册：PROSPERO 2019：CRD42019125869