Serum Albumin and Its Trajectory Are Associated With Therapeutic Outcomes in Ulcerative Colitis

The relationship between serum albumin levels and therapeutic outcomes in ulcerative colitis (UC) has been debated. Additionally, the dynamic changes in albumin levels remain understudied.

We conducted a pooled analysis of 5 clinical trials involving 3268 patients with UC. Short- and long-term therapeutic outcomes were assessed at the end of the induction and maintenance phases. Multivariable logistic regression and random effects models were used to pool the predictive effects of albumin levels. The dynamic trajectory of albumin was fitted using latent class growth mixed models.

Baseline and week-2 albumin were independent predictors of short-term outcomes, with pooled adjusted odds ratios (aORs) of 1.07 (95% confidence interval [CI],1.05-1.09) and 1.11 (95% CI, 1.08-1.15) per 1 g/L increase for clinical response, respectively. Higher post-induction albumin levels predicted better long-term outcomes, including clinical (aOR, 1.16; 95% CI, 1.12-1.21), endoscopic (aOR, 1.13; 95% CI, 1.10-1.16), and histologic remission (aOR, 1.11; 95% CI, 1.03-1.18). Furthermore, there were 3 categories of albumin trajectories: sustained medium-to-high, rapidly ascending, and poor response. Compared with the sustained medium-to-high category, patients in the poor response category had a lower probability of long-term endoscopic remission (aOR, 0.35; 95% CI, 0.23-0.50; P < .001), whereas no significant difference was observed between the rapidly ascending category and the sustained medium-to-high category.

Higher albumin levels were associated with better therapeutic outcomes in patients with UC. However, patients with low but rapidly ascending albumin levels would achieve outcomes comparable to those with medium-to-high levels of albumin.