血清白蛋白与总体死亡率呈负相关，但其与特定死因的关系仍不确定。本研究旨在调查低白蛋白血症（定义为血清白蛋白水平≤35 g/L）是否与癌症和/或血管疾病导致的死亡率相关。血清白蛋白水平是在基于人群的 Moli- 前瞻性队列中测量的。 sani 研究，建立于 2005 年至 2010 年之间。低白蛋白血症的定义为血清白蛋白水平≤35 g/L。使用经过验证的意大利死亡率登记处评估特定原因死亡率，并根据国际疾病分类第 9 版进行编码。在 13.1 年的中位随访期内，研究了血清白蛋白与死亡率之间的关系（针对协变量进行了调整）使用竞争风险生存分析。分析的队列由 17,930 名年龄≥35 岁的个体组成，其中 8445 名是男性（47.1%）。平均年龄为 54 岁（标准差 (SD) = 11 岁），其中 3299 人 (18.4%) 年龄超过 65 岁。所有参与者的 C 反应蛋白水平均低于 10 mg/L，并且没有肝脏、肾脏、心血管或癌症疾病史。 406 人 (2.3%) 发现低白蛋白血症。该研究共记录了 1428 例死亡，其中 574 例死于癌症，464 例死于血管原因。与血清白蛋白 >40 g/L 相比，低白蛋白血症与死亡率独立相关（风险比 (HR) = 1.61，95% 置信区间：1.21-2.13）。血清白蛋白水平每降低 1-SD，总死亡率、血管死亡率和癌症死亡率的 HR 分别为 1.16 (1.09-1.22)、1.16 (1.05-1.28) 和 1.13 (1.03-1.23)。按年龄分层后，低白蛋白血症仅在年龄≥65岁的人群中与总死亡率相关（HR=1.83；1.33-2.50），但在<65岁组中则不相关（HR=1.03；0.53-2.00；差异P<0.0001） 。血管性死亡（每减少 1-SD，HR = 1.19；≥65 岁个体为 1.07-1.33，HR = 1.05；65 岁以下个体为 0.86-1.29）和癌症死亡率（HR = 1.15；1.02）也出现了类似的年龄相关模式。 -1.30；≥65 岁且 HR = 1.08；0.96-1.23；<65 岁）。血清白蛋白水平≤35 g/L 的个体总体死亡、癌症和血管死亡的风险较高。由下一代欧盟资助的项目“Age-It - 在老龄化社会中健康老龄化”项目 (PE0000015)、国家恢复和复原力计划 (NRRP)-PE8-Mission 4、C2、干预 1.3。© 2024 作者（s）。

Serum albumin is inversely associated with overall mortality, but its association with specific causes of death remains uncertain. This study aims to investigate whether hypoalbuminemia, defined as serum albumin levels ≤35 g/L, is associated with mortality specifically attributed to cancer and/or vascular diseases.Serum albumin levels were measured in the population-based, prospective cohort of the Moli-sani study, established between 2005 and 2010. Hypoalbuminemia was defined as serum albumin levels ≤35 g/L. Cause-specific mortality was assessed using the validated Italian mortality registry and coded according to the International Classification of Diseases, Revision 9. Over a median follow-up period of 13.1 years, the relationship between serum albumin and mortality, adjusted for covariates, was investigated using competing-risk survival analysis.The analysed cohort comprised 17,930 individuals aged ≥35 years, of whom 8445 were men (47.1%). The mean age was 54 years (standard deviation (SD) = 11 years), with 3299 individuals (18.4%) aged older than 65 years. All participants had C-reactive protein levels <10 mg/L and no history of liver, renal, cardiovascular, or cancer disease. Hypoalbuminemia was found in 406 individuals (2.3%). The study documented a total of 1428 deaths, with 574 attributed to cancer and 464 to vascular causes. Hypoalbuminemia was independently associated with mortality when compared to serum albumin >40 g/L (Hazard Ratio (HR) = 1.61, 95% Confidence Interval: 1.21-2.13). A decrease of 1-SD in serum albumin levels corresponded to HR of 1.16 (1.09-1.22), 1.16 (1.05-1.28), and 1.13 (1.03-1.23) for total, vascular and cancer mortality, respectively. Upon stratifying by age, hypoalbuminemia was associated with total mortality solely in those aged ≥65 years (HR = 1.83; 1.33-2.50) but not in the <65 years group (HR = 1.03; 0.53-2.00; P < 0.0001 for difference). Similar age-related patterns emerged for vascular death (per 1-SD decrease HR = 1.19; 1.07-1.33 in individuals ≥65 years and HR = 1.05; 0.86-1.29 in individuals <65 years) and cancer mortality (HR = 1.15; 1.02-1.30; ≥65 years and HR = 1.08; 0.96-1.23; <65 years).Individuals ≥65 years old with serum albumin levels ≤35 g/L are at higher risk of total, cancer, and vascular mortality.This paper was developed within the project funded by Next Generation EU-"Age-It - Ageing well in an ageing society" project (PE0000015), National Recovery and Resilience Plan (NRRP)-PE8-Mission 4, C2, Intervention 1.3.© 2024 The Author(s).