Dynamic Changes in Albumin Predict Long-Term Outcomes in Ulcerative Colitis
A pooled analysis of five clinical trials involving 3,268 patients with ulcerative colitis (UC) has identified serum albumin levels—both baseline and early changes—as independent predictors of treatment outcomes across both induction and maintenance phases.
Higher albumin levels at baseline and at week 2 were significantly associated with short-term clinical response. Specifically, the adjusted odds ratio (aOR) per 1 g/L increase was 1.07 at baseline and 1.11 at week 2. Post-induction albumin also predicted long-term clinical (aOR 1.16), endoscopic (aOR 1.13), and histologic remission (aOR 1.11).
“Higher albumin levels were associated with better therapeutic outcomes in patients with UC,” the authors stated. However, the study also emphasized the importance of albumin dynamics.
Using latent class growth mixed models, researchers identified three albumin trajectory categories: sustained medium-to-high, rapidly ascending, and poor response. Patients in the poor response category had significantly lower odds of achieving long-term endoscopic remission (aOR 0.35; 95% CI, 0.23–0.50; P < .001) compared to the sustained medium-to-high group.
Importantly, patients with low but rapidly increasing albumin levels showed outcomes comparable to those with sustained higher albumin, suggesting early albumin recovery may be as informative as baseline levels. “Patients with low but rapidly ascending albumin levels would achieve outcomes comparable to those with medium-to-high levels of albumin,” the authors noted.
For practicing gastroenterologists, these findings highlight the value of monitoring early changes in albumin during induction therapy, not just static values, as a tool for assessing treatment trajectory and tailoring clinical decision-making.
Reference
Zheng J, Zhang X, Zhang L, et al. Serum albumin and its trajectory are associated with therapeutic outcomes in ulcerative colitis. Clin Gastroenterol Hepatol. 2025;23(10):1808-1816. doi:10.1016/j.cgh.2024.10.036
