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Original Research: LUNG TRANSPLANTATION |

Serum Albumin Concentration and Waiting List Mortality in Idiopathic Interstitial Pneumonia

David A. Zisman, MD, MS, FCCP; Steven M. Kawut, MD, MS, FCCP; David J. Lederer, MD, MS, FCCP; John A. Belperio, MD; Joseph P. Lynch, III, MD, FCCP; Marvin I. Schwarz, MD, FCCP; John A. Tayek, MD; David B. Reuben, MD; Arun S. Karlamangla, PhD, MD
Author and Funding Information

*From the Department of Medicine (Drs. Zisman, Belperio, Lynch, Reuben, and Karlamangla), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA; Department of Internal Medicine (Dr. Tayek), Harbor-UCLA Medical Center, Los Angeles, CA; Department of Medicine (Drs. Kawut and Lederer), College of Physicians and Surgeons, Columbia University, New York, NY; and Department of Medicine (Dr. Schwarz), University of Colorado Health Sciences Center, Denver, CO.

Correspondence to: David A. Zisman, MD, MS, FCCP, Interstitial Lung Disease Center, David Geffen School of Medicine at UCLA, 37-131 Center for Health Sciences, Los Angeles, CA 90095; e-mail: dzisman@mednet.ucla.edu


All the work was performed at the David Geffen School of Medicine at UCLA.

The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.

This work was supported, in part, by grants from the National Institutes of Health (5U10HL080411 to D.A.Z.; HL080206 and HL086491 to J.A.B.; R21AT002394 to J.A.T.; and 5P30AG028748 to A.S.K.). This work was supported in part by Health Resources and Services Administration contract 234-2005-370011C.

Dr. Zisman received research grants from Intermune and Actelion Pharmaceuticals to do multicenter studies in IPF. Drs. Zisman and Schwarz receive funds from the National Institutes of Health IPF Clinical Research Network, which involves participation in a pulmonary hypertension study with sildenafil. Dr. Kawut received honoraria from Actelion, Encysive, Gilead and United Therapeutics and funding for research from Intermune. None of the other authors have any other conflicts of interest to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(4):929-935. doi:10.1378/chest.08-0754
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Background:  Hypoalbuminemia is a reliable predictor of mortality in patients with various illnesses as well as a predictor of disability and mortality in healthy older adults. The association between hypoalbuminemia and mortality in patients with idiopathic interstitial pneumonia remains unknown. The objective of this study was to examine the relationship between serum albumin concentration and mortality in a large cohort of patients with idiopathic interstitial pneumonia listed for lung transplantation.

Methods:  In patients classified as having idiopathic pulmonary fibrosis who were listed for lung transplantation with the United Network for Organ Sharing between January 1, 2004, and December 31, 2006 (n = 1,269), we studied the relationship between serum albumin concentration at the time of listing and mortality while awaiting transplantation.

Results:  Lower serum albumin was associated with increased mortality rate. Patients with lower categories of serum albumin had increased mortality rates before and after multivariable adjustment (p value for linear trend < 0.0001). Analysis with serum albumin as a continuous predictor indicated that the mortality rate increased by 54% with each 0.5 g/dL decrease in serum albumin concentration (95% confidence interval, 32 to 79%).

Conclusions:  Lower serum albumin is strongly and independently associated with higher mortality in patients with idiopathic interstitial pneumonia on transplant waiting lists.

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