Background/Purpose: When a complex patient with long term lupus is seen for the first time, there is a need for a readily and commonly available serum marker to graphically indicate the severity and course of their disease. Serum albumin levels are known to reflect SLE activity, especially lupus nephritis, but the utility of this marker to assess longitudinal activity has not been studied.  Here we have compared serum albumin levels with other measures of lupus activity

Methods: We selected 10 patients with lupus nephritis followed at the USC+LAC Medical Center for 1 to 10 years.  Other patients without nephritis were also studied. Using the urine protein/creatinine (UPC) ratio as a reference standard for nephritis, we looked for the correlation with serum albumin levels, ESR, CRP, hematocrit, anti-dsDNA levels, serum C3, and C4. Both Pearson and Spearman r values were calculated and p values determined. The UPC of patients studied was >2.

Results:  The Table shows that changes in serum albumin levels correlated highly with UPC in all patients studied (p <0.01).  C3 levels were the only other marker to correlate significantly with UPC in more than one half of the half the subjects. However, as an example of how lab markers can relate to UPC, Fig.1 shows a significant correlation of all markers examined in a patient we treated for more than 8 years. In cases without lupus nephritis, similar decreases in serum albumin levels were observed in patients with severe organ system disease, but not in lupus patients with only moderate skin involvement or serositis. There was no relationship with serum albumin levels disease activity in most cases of rheumatoid arthritis.

Conclusion: With the increased use of the computerized medical record, we believe that in the first encounter of a lupus patient with longstanding disease, graphing serum albumin levels will reveal useful information regarding the severity of systemic activity, and the dates of this involvement.  Inspection of the medical record on these dates will reveal the response or lack of response to the agents used, and the rheumatologist can then rapidly formulate the appropriate treatment regimen for that patient in a timely manner.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/changes-in-serum-albumin-levels-correlate-highly-with-severity-and-activity-of-sle/