European Journal of Cardiovascular Medicine

Serum albumin, the most abundant plasma protein, performs multiple homeostatic functions including maintenance of oncotic pressure, transport of endogenous and exogenous compounds, antioxidant activity and modulation of inflammatory responses. Low serum albumin (hypoalbuminemia) frequently develops early in the course of critical illness as a result of systemic inflammation, capillary leak, redistribution and altered hepatic synthesis, and it therefore represents an integrated marker of both nutritional and disease severity [1].

Prognostic importance of albumin in intensive care populations has been repeatedly reported. Large database analyses and single-center cohorts have shown a stepwise increase in mortality as admission albumin declines, and admission hypoalbuminemia has been independently associated with higher in-hospital and 28-day mortality after adjustment for conventional severity scores [2,3]. Beyond a single baseline measurement, several investigators have emphasized the additional value of serial albumin kinetics: progressive decline or failure of albumin to recover during the early hospital course has been correlated with worse outcomes, prolonged organ support and failure to wean from mechanical ventilation [4,5].

Despite this accumulating evidence, much of the available literature comprises retrospective analyses or heterogeneous patient populations, and prospective observational data from medical intensive care settings—especially from resource-limited tertiary hospitals—remain comparatively sparse. Furthermore, the relationship between admission albumin categories, subsequent temporal albumin trajectories and specific morbidity indicators such as requirement for mechanical ventilation has not been uniformly quantified across studies [6].

Accordingly, the present prospective, hospital-based observational study enrolled 100 critically ill patients admitted to the MICU and ICCU to evaluate whether admission serum albumin and its serial measurements over the first 10 days of hospitalization are associated with survival and key morbidity outcomes (mechanical ventilation and duration of hospital stay). By analysing both admission categories and longitudinal albumin trends, we aimed to clarify the prognostic utility of albumin monitoring in a tertiary care medical ICU population.

Study Design and Setting

This hospital-based observational study was conducted in the Department of Dermatology at the RVM Institute of Medical Sciences & Research Center, Mulugu, Siddipet, Telangana. The study spanned five months, from May 2025 to September 2025, and included all eligible patients attending the dermatology outpatient clinic during this period.

Study Population and Sample Size

A total of 100 adult patients were enrolled consecutively. Individuals aged 18 years and above, presenting with dermatological complaints and having at least one confirmed systemic disease, were eligible for inclusion. Patients with isolated infectious skin disorders without systemic involvement, those undergoing chemotherapy, or those unwilling to provide consent were excluded from participation.

Data Collection Procedures

A structured proforma was used to capture demographic details such as age, gender, and residence. Information regarding systemic diseases, including type and duration, was obtained from medical records and clinical evaluation. Each participant underwent a detailed dermatological examination performed by the same clinical team to ensure uniform assessment.

Cutaneous markers associated with systemic conditions—such as acanthosis nigricans, skin tags, pretibial edema, xerosis, palmar erythema, and spider nevi—were documented meticulously. The duration of systemic illness was categorized into two groups: less than five years, and five years or more.

Data Management and Statistical Analysis

All collected data were entered into a secure database and cross-checked for completeness and accuracy. Descriptive statistics were used to summarize clinical profiles and dermatological findings. Frequencies, percentages, and means were calculated as appropriate. Tables were prepared to present the distribution of systemic diseases and their associated cutaneous manifestations.

Ethical Considerations

Written informed consent was obtained from all participants before enrolment. Confidentiality of patient information was maintained throughout the study. Ethical approval was secured from the Institutional Ethics Committee of RVM Institute of Medical Sciences & Research Center prior to data collection.

A total of 100 patients were included in the study. Their mean age was 42.6 ± 13.4 years, and the sample showed a near-equal gender distribution, with 54% males and 46% females. Most participants were from urban areas, reflecting the referral pattern of the hospital (Table 1).

Table 1. Demographic Profile of Participants (N = 100)

All patients had at least one systemic illness. Diabetes mellitus emerged as the most frequent condition, affecting 38% of the cohort, followed by hypertension in 31%. Thyroid disorders accounted for 14% of cases, while chronic liver disease and chronic kidney disease were seen in 10% and 7% of the sample, respectively (Table 2).

Table 2. Distribution of Systemic Diseases Among Participants

A wide range of cutaneous markers was identified during clinical examination. Acanthosis nigricans was the predominant finding, documented in 28% of patients. Skin tags were observed in 22%, while pretibial edema appeared in 18% of the sample. Xerosis was reported in 15 individuals, and features linked with hepatic disease, such as palmar erythema and spider nevi, were noted in 7% and 5% of patients, respectively (Table 3).

Table 3. Cutaneous Manifestations Noted in the Study Population

The pattern of skin changes showed a clear relationship with the duration of systemic illness. Patients with more than five years of disease demonstrated a higher burden of dermatological manifestations, with 58.5% displaying multiple cutaneous markers. In contrast, only 28.8% of those with less than five years of illness showed similar clustering of signs (Table 4). This trend highlights the progressive nature of cutaneous involvement as systemic diseases evolve.

Table 4. Association of Cutaneous Findings With Systemic Illness Duration

This observational study examined the spectrum of cutaneous manifestations associated with systemic diseases in adults attending a tertiary dermatology clinic. The findings revealed a strong association between internal disorders and specific skin signs, reinforcing long-standing evidence that the skin often reflects underlying systemic pathology and serves as an accessible diagnostic clue [7]. Earlier descriptions have emphasized that many metabolic and cardiovascular conditions present with recognizable dermatological patterns, and the present study aligns well with this understanding [8].

Metabolic and lifestyle-related illnesses dominated the systemic disease profile in this cohort, particularly diabetes mellitus and hypertension. Diabetes accounted for 38% of cases, and its characteristic markers—such as acanthosis nigricans and skin tags—were frequently observed. This is consistent with classical literature linking insulin resistance to thickened, hyperpigmented skin folds and multiple fibroepithelial polyps [7,9]. These features often appear early, making them important indicators in individuals who may not be screened routinely. Hypertension and thyroid disorders also contributed substantially, with pretibial edema and xerosis reflecting recognized physiological alterations described in systemic and metabolic illnesses [8,12].

Cutaneous signs associated with hepatic dysfunction, including palmar erythema and spider nevi, appeared prominently among patients with chronic liver disease. These findings correspond with established mechanisms involving estrogen excess, vascular dilation, and impaired hepatic metabolism, as highlighted in prior dermatology and internal medicine literature [9,12]. Similarly, the presence of multiple cutaneous markers in individuals with long-standing systemic illness echoes observations from earlier studies, which noted that the severity and variety of skin changes tend to increase as metabolic stress and chronic inflammation accumulate over time [10,11].

The association between disease duration and dermatological involvement in this study where more than half of patients with systemic illness ≥5 years exhibited multiple skin changes supports the concept that cutaneous markers may serve as indicators of disease progression. This aligns with prior work showing that chronic metabolic or malignant conditions often manifest through evolving skin signs that become more pronounced with advancing disease [11,13].

The findings also emphasize the need for interdisciplinary collaboration. Many patients initially present to dermatology for cosmetic or symptomatic concerns without recognizing the systemic significance of their skin changes. Early recognition of these signs enables dermatologists to guide timely referrals to internal medicine, endocrinology, gastroenterology, or oncology, thereby improving diagnostic efficiency and patient outcomes. Similar recommendations have been highlighted in previous reviews that advocate integrating dermatological assessment into routine systemic disease evaluation [12,13].

The study does have limitations. The sample size was relatively small, and data were drawn from a single tertiary care center, limiting generalizability. Diagnostic confirmation relied partly on patient records, and uniform laboratory reassessment was not performed. Nonetheless, the study offers meaningful insight into the cutaneous–systemic interface and reflects real-world patterns noted in earlier regional and global reports [7–13].

This study demonstrated a strong association between systemic diseases and distinct cutaneous markers among patients attending a tertiary dermatology clinic. Diabetes mellitus, hypertension, and thyroid disorders were the most frequent conditions, and each showed characteristic skin changes such as acanthosis nigricans, skin tags, pretibial edema, and xerosis. Patients with long-standing illness were more likely to exhibit multiple skin findings, highlighting the progressive nature of dermatological involvement. These observations reinforce the value of routine skin examination as an accessible indicator of underlying systemic disease. Early recognition of such markers can support timely diagnosis, guide referral, and enhance integrated management for better patient outcomes.

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