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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter

IMPACT FACTOR 2018: 3.638

CiteScore 2018: 2.44

SCImago Journal Rank (SJR) 2018: 1.191
Source Normalized Impact per Paper (SNIP) 2018: 1.205

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Volume 45, Issue 3


Clinical indications for plasma protein assays: transthyretin (prealbumin) in inflammation and malnutrition: International Federation of Clinical Chemistry and Laboratory Medicine (IFCC): IFCC Scientific Division Committee on Plasma Proteins (C-PP)

A. Myron Johnson
  • Departments of Pediatrics and Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Giampaolo Merlini
  • Biotechnology Research Laboratories, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Department of Biochemistry, University of Pavia, Pavia, Italy
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Joanna Sheldon / Kiyoshi Ichihara
Published Online: 2007-03-22 | DOI: https://doi.org/10.1515/CCLM.2007.051


A large number of circumstances are associated with reduced serum concentrations of transthyretin (TTR), or prealbumin. The most common of these is the acute phase response, which may be due to inflammation, malignancy, trauma, or many other disorders. Some studies have shown a decrease in hospital stay with nutritional therapy based on TTR concentrations, but many recent studies have shown that concentrations of albumin, transferrin, and transthyretin correlate with severity of the underlying disease rather than with anthropometric indicators of hypo- or malnutrition.

There are few if any conditions in which the concentration of this protein by itself is more helpful in diagnosis, prognosis, or follow up than are other clinical findings. In the majority of cases, the serum concentration of C-reactive protein is adequate for detection and monitoring of acute phase responses and for prognosis. Although over diagnosis and treatment of presumed protein energy malnutrition is probably not detrimental to most patients, the failure to detect other causes of decreased concentrations (such as serious bacterial infections or malignancy) of the so-called visceral or hepatic proteins could possibly result in increased morbidity or even mortality. In addition to these caveats, assays for TTR have a relatively high level of uncertainty (“imprecision”). Clinical evaluation – history and physical examination – should remain the mainstay of nutritional assessment.

Clin Chem Lab Med 2007;45:419–26.

Keywords: inflammation; malnutrition; prealbumin; transthyretin

About the article

Corresponding author: Andrew Myron Johnson, MD, 610 Bruton Place South, Greensboro, NC 27410-4660, USA Phone: +1-336-292-2072; Fax: +1-919-966-1999,

Received: November 28, 2006

Published Online: 2007-03-22

Published in Print: 2007-03-01

Citation Information: Clinical Chemical Laboratory Medicine, Volume 45, Issue 3, Pages 419–426, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/CCLM.2007.051.

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