Hypoalbuminemia and lymphocytopenia in patients with decompensated biventricular failure

In patients hospitalized with decompensated biventricular failure having hypoalbuminemia and lymphocytopenia without underlying hepatic or renal disease, we addressed the presence of a protein-losing enteropathy (PLE). We studied 78 patients having a dilated cardiomyopathy, who were hospitalized wit...

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Bibliographic Details
Published in:	The American journal of the medical sciences Vol. 339; no. 1; p. 31
Main Authors:	Battin, David L, Ali, Sheharyar, Shahbaz, Atta U, Massie, J Daniel, Munir, Ahmad, Davis, Jr, Richard C, Newman, Kevin P, Weber, Karl T
Format:	Journal Article
Language:	English
Published:	United States 01-01-2010
Subjects:	Adult Aged Aged, 80 and over Cardiomyopathy, Dilated - complications Cardiomyopathy, Dilated - diagnostic imaging Female Follow-Up Studies Heart Failure - complications Heart Failure - diagnostic imaging Humans Hypoalbuminemia - complications Hypoalbuminemia - diagnostic imaging Lymphopenia - complications Lymphopenia - diagnostic imaging Male Middle Aged Protein-Losing Enteropathies - complications Protein-Losing Enteropathies - diagnostic imaging Radionuclide Imaging
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Summary:	In patients hospitalized with decompensated biventricular failure having hypoalbuminemia and lymphocytopenia without underlying hepatic or renal disease, we addressed the presence of a protein-losing enteropathy (PLE). We studied 78 patients having a dilated cardiomyopathy, who were hospitalized with congestive heart failure (CHF) and hypoalbuminemia of uncertain origin. In the first 19 patients, we investigated the presence of PLE using Tc-Dex scintigraphy together with serum albumin 2 to 4 weeks later when compensation had been restored. In the next 59 patients, presenting with reduced serum albumin and relative lymphocyte count at admission, these parameters were again monitored (2-4 weeks) later when symptoms and signs of CHF had resolved. PLE, documented by Tc-Dex(70) scintigraphy, was found in 10 of 19 patients and whose hypoalbuminemia (2.7 +/- 0.1 g/dL, mean +/- standard error of mean) were corrected (3.3 +/- 0.1 g/dL; P < 0.05) with the resolution of CHF, whereas in the 9 patients without a PLE, reduced baseline serum albumin (2.6 +/- 0.1 g/dL) failed to improve on follow-up (2.6 +/- 0.2 g/dL) in keeping with malnutrition. Relative lymphocyte count was reduced (14.6 +/- 1.5%) in patients with PLE but was normal (21.4 +/- 3.3%; P < 0.05) in those without PLE. Serum albumin and relative lymphocyte count were each reduced at admission (2.8 +/- 0.1 g/dL and 14.4 +/- 1.0%, respectively) in 59 patients and increased (P < 0.05) to normal values (3.5 +/- 0.1 g/dL and 24.9 +/- 1.0%) 2 to 4 weeks after they were compensated. Enteral losses of albumin and lymphocytes account for the reversible hypoalbuminemia and lymphocytopenia found in patients hospitalized with CHF having splanchnic congestion.
ISSN:	1538-2990
DOI:	10.1097/MAJ.0b013e3181bfc83f