Transthyretin Measurement as a Screening Tool for Protein Calorie Malnutrition in Emergency Hospital Admissions

In this study the impact of malnutrition on hospitalized patients and the value of using transthyretin level as a screening test for malnutrition were evaluated. One hundred and forty seven consecutive patients admitted through the emergency department were included in the study. The primary outcome measures were length of stay in hospital, in-hospital mortality, and nutritional supplementation in patients with malnutrition. A cost analysis of screening with transthyretin was also performed. In 24% of the patients in the study malnutrition was diagnosed (transthyretin level < 160 mg/l), however, by determination of the albumin level (< 35 g/l) only 50% of these patients could be identified. The length of stay and mortality were 16±18 days and 17%, respectively, in patients with malnutrition, compared to 8±12 days and 4% in patients without malnutrition (p < 0.0002 and p < 0.02, respectively). Only 42% of patients with malnutrition received nutritional supplementation. Cost analysis of screening with transthyretin level projected a saving of $414 per patient screened. We conclude that malnutrition is underdiagnosed in current clinical practice and is associated with poor outcomes. Transthyretin is a biochemical marker that could be used as a cost-effective screening test to identify patients with malnutrition who may benefit from nutritional supplementation.