Serum Prealbumin

1. See Also
   1. Malnutrition Labs
2. Indications
   1. Malnutrition Evaluation (See Malnutrition Labs)
   2. Monitoring of nutritional improvement
3. Efficacy
   1. Correlates with clinical outcomes
   2. Prealbumin is the best marker of malnutrition
      1. Short serum half-life
      2. Less affect by liver disease than other proteins
      3. Not affected by hydration status
      4. Not affected by Vitamin Deficiency (except zinc)
4. Pathophysiology
   1. Serum half-life: 2 days
   2. High essential to nonessential amino acid ratio
   3. Production
      1. Liver is primary source
      2. Other sites of production
         1. Choroid plexus
         2. Enterochromaffin cells in gastrointestinal mucosa
5. Normal
   1. Prealbumin: 16 to 35 mg/dl
6. Increased Serum Prealbumin
   1. Alcohol Abuse (especially binge drinking)
      1. Prealbumin returns to baseline after 7 days
   2. Medications
      1. Corticosteroids (e.g. Prednisone)
      2. Progesterone and related agents
7. Decreased Serum Prealbumin
   1. Protein Malnutrition
   2. Other Causes
      1. Zinc Deficiency
      2. Negative acute phase reactant
         1. Decreases with inflammation or post-surgery
8. Interpretation in Malnutrition
   1. Protein Malnutrition Diagnosis
      1. Prealbumin <5 mg/dl: Predicts poor prognosis
      2. Prealbumin <11 mg/dl: High risk
         1. Requires aggressive Nutritional Supplementation
      3. Prealbumin <15: Increased risk of malnutrition
         1. Monitoring recommended twice weekly
      4. Reference
         1. Bernstein (1995) Nutrition 11:170
   2. Protein Malnutrition Monitoring
      1. Findings suggestive of adequate nutritional support
         1. Prealbumin level rising 2 mg/dl per day
         2. Prealbumin level returns to normal by 8 days
      2. Findings requiring intense nutritional (e.g. TPN)
         1. Prealbumin level rises <4 mg/dl in 8 days
9. References
   1. Beck (2002) Am Fam Physician 65:1575-8