Clinical indications for plasma protein assays: Transthyretin (prealbumin) in inflammation and malnutrition - International federation of clinical chemistry and laboratory medicine (IFCC): IFCC scientific division committee on plasma proteins (C-PP)

A. Myron Johnson, Giampaolo Merlini, Joanna Sheldon, Kiyoshi Ichihara

Research output: Contribution to journalArticle

Abstract

A large number of circumstances are associated with reduced serum concentrations of transthyretin (TTR), or prealbumin. The most common of these is the acute phase response, which may be due to inflammation, malignancy, trauma, or many other disorders. Some studies have shown a decrease in hospital stay with nutritional therapy based on TTR concentrations, but many recent studies have shown that concentrations of albumin, transferrin, and transthyretin correlate with severity of the underlying disease rather than with anthropometric indicators of hypo- or malnutrition. There are few if any conditions in which the concentration of this protein by itself is more helpful in diagnosis, prognosis, or follow up than are other clinical findings. In the majority of cases, the serum concentration of C-reactive protein is adequate for detection and monitoring of acute phase responses and for prognosis. Although over diagnosis and treatment of presumed protein energy malnutrition is probably not detrimental to most patients, the failure to detect other causes of decreased concentrations (such as serious bacterial infections or malignancy) of the so-called visceral or hepatic proteins could possibly result in increased morbidity or even mortality. In addition to these caveats, assays for TTR have a relatively high level of uncertainty ("imprecision"). Clinical evaluation - history and physical examination - should remain the mainstay of nutritional assessment.

Original languageEnglish
Pages (from-to)419-426
Number of pages8
JournalClinical Chemistry and Laboratory Medicine
Volume45
Issue number3
DOIs
Publication statusPublished - Mar 1 2007

Fingerprint

Clinical laboratories
Clinical Chemistry
Prealbumin
Malnutrition
Medicine
Blood Proteins
Assays
Inflammation
Acute-Phase Reaction
Protein-Energy Malnutrition
Nutrition Assessment
Proteins
Transferrin
Serum
Bacterial Infections
C-Reactive Protein
Physical Examination
Uncertainty
Albumins
Length of Stay

Keywords

  • Inflammation
  • Malnutrition
  • Prealbumin
  • Transthyretin

ASJC Scopus subject areas

  • Clinical Biochemistry

Cite this

@article{9feb238d2ce14ceab3a62ba88442258c,
title = "Clinical indications for plasma protein assays: Transthyretin (prealbumin) in inflammation and malnutrition - International federation of clinical chemistry and laboratory medicine (IFCC): IFCC scientific division committee on plasma proteins (C-PP)",
abstract = "A large number of circumstances are associated with reduced serum concentrations of transthyretin (TTR), or prealbumin. The most common of these is the acute phase response, which may be due to inflammation, malignancy, trauma, or many other disorders. Some studies have shown a decrease in hospital stay with nutritional therapy based on TTR concentrations, but many recent studies have shown that concentrations of albumin, transferrin, and transthyretin correlate with severity of the underlying disease rather than with anthropometric indicators of hypo- or malnutrition. There are few if any conditions in which the concentration of this protein by itself is more helpful in diagnosis, prognosis, or follow up than are other clinical findings. In the majority of cases, the serum concentration of C-reactive protein is adequate for detection and monitoring of acute phase responses and for prognosis. Although over diagnosis and treatment of presumed protein energy malnutrition is probably not detrimental to most patients, the failure to detect other causes of decreased concentrations (such as serious bacterial infections or malignancy) of the so-called visceral or hepatic proteins could possibly result in increased morbidity or even mortality. In addition to these caveats, assays for TTR have a relatively high level of uncertainty ({"}imprecision{"}). Clinical evaluation - history and physical examination - should remain the mainstay of nutritional assessment.",
keywords = "Inflammation, Malnutrition, Prealbumin, Transthyretin",
author = "Johnson, {A. Myron} and Giampaolo Merlini and Joanna Sheldon and Kiyoshi Ichihara",
year = "2007",
month = "3",
day = "1",
doi = "10.1515/CCLM.2007.051",
language = "English",
volume = "45",
pages = "419--426",
journal = "Clinical Chemistry and Laboratory Medicine",
issn = "1434-6621",
publisher = "Walter de Gruyter GmbH",
number = "3",

}

TY - JOUR

T1 - Clinical indications for plasma protein assays

T2 - Transthyretin (prealbumin) in inflammation and malnutrition - International federation of clinical chemistry and laboratory medicine (IFCC): IFCC scientific division committee on plasma proteins (C-PP)

AU - Johnson, A. Myron

AU - Merlini, Giampaolo

AU - Sheldon, Joanna

AU - Ichihara, Kiyoshi

PY - 2007/3/1

Y1 - 2007/3/1

N2 - A large number of circumstances are associated with reduced serum concentrations of transthyretin (TTR), or prealbumin. The most common of these is the acute phase response, which may be due to inflammation, malignancy, trauma, or many other disorders. Some studies have shown a decrease in hospital stay with nutritional therapy based on TTR concentrations, but many recent studies have shown that concentrations of albumin, transferrin, and transthyretin correlate with severity of the underlying disease rather than with anthropometric indicators of hypo- or malnutrition. There are few if any conditions in which the concentration of this protein by itself is more helpful in diagnosis, prognosis, or follow up than are other clinical findings. In the majority of cases, the serum concentration of C-reactive protein is adequate for detection and monitoring of acute phase responses and for prognosis. Although over diagnosis and treatment of presumed protein energy malnutrition is probably not detrimental to most patients, the failure to detect other causes of decreased concentrations (such as serious bacterial infections or malignancy) of the so-called visceral or hepatic proteins could possibly result in increased morbidity or even mortality. In addition to these caveats, assays for TTR have a relatively high level of uncertainty ("imprecision"). Clinical evaluation - history and physical examination - should remain the mainstay of nutritional assessment.

AB - A large number of circumstances are associated with reduced serum concentrations of transthyretin (TTR), or prealbumin. The most common of these is the acute phase response, which may be due to inflammation, malignancy, trauma, or many other disorders. Some studies have shown a decrease in hospital stay with nutritional therapy based on TTR concentrations, but many recent studies have shown that concentrations of albumin, transferrin, and transthyretin correlate with severity of the underlying disease rather than with anthropometric indicators of hypo- or malnutrition. There are few if any conditions in which the concentration of this protein by itself is more helpful in diagnosis, prognosis, or follow up than are other clinical findings. In the majority of cases, the serum concentration of C-reactive protein is adequate for detection and monitoring of acute phase responses and for prognosis. Although over diagnosis and treatment of presumed protein energy malnutrition is probably not detrimental to most patients, the failure to detect other causes of decreased concentrations (such as serious bacterial infections or malignancy) of the so-called visceral or hepatic proteins could possibly result in increased morbidity or even mortality. In addition to these caveats, assays for TTR have a relatively high level of uncertainty ("imprecision"). Clinical evaluation - history and physical examination - should remain the mainstay of nutritional assessment.

KW - Inflammation

KW - Malnutrition

KW - Prealbumin

KW - Transthyretin

UR - http://www.scopus.com/inward/record.url?scp=33947609131&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33947609131&partnerID=8YFLogxK

U2 - 10.1515/CCLM.2007.051

DO - 10.1515/CCLM.2007.051

M3 - Article

C2 - 17378745

AN - SCOPUS:33947609131

VL - 45

SP - 419

EP - 426

JO - Clinical Chemistry and Laboratory Medicine

JF - Clinical Chemistry and Laboratory Medicine

SN - 1434-6621

IS - 3

ER -