Korean J Crit Care Med.  2017 Nov;32(4):347-355. 10.4266/kjccm.2017.00437.

Serum Albumin as a Biomarker of Poor Prognosis in the Pediatric Patients in Intensive Care Unit

Affiliations
  • 1Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea. yhkim@yuhs.ac
  • 2Department of Pediatrics, Severance Hospital, Seoul, Korea.
  • 3Department of Pediatrics, Gangnam Severance Hospital, Seoul, Korea.
  • 4Sowha Children's Hospital, Seoul, Korea.

Abstract

BACKGROUND
Serum albumin as an indicator of the disease severity and mortality is suggested in adult patients, but its role in pediatric patients has not been established. The objectives of this study are to investigate the albumin level as a biomarker of poor prognosis and to compare it with other mortality predictive indices in children in intensive care unit (ICU).
METHODS
Medical records of 431 children admitted to the ICU at Severance Hospital from January 1, 2012 to December 31, 2015 were retrospectively analyzed. Children who expired within 24 hours after ICU admission, children with hepatic or renal failure, and those who received albumin replacement before ICU admission were excluded.
RESULTS
The children with hypoalbuminemia had higher 28-day mortality rate (24.60% vs. 9.28%, P < 0.001), Pediatric Index of Mortality (PIM) 3 score (9.23 vs. 8.36, P < 0.001), Pediatric Risk of Mortality (PRISM) III score (7.0 vs. 5.0, P < 0.001), incidence of septic shock (12% vs. 3%, P < 0.001), C-reactive protein (33.0 mg/L vs. 5.8 mg/L, P < 0.001), delta neutrophil index (2.0% vs. 0.6%, P < 0.001), lactate level (1.6 mmol/L vs. 1.2 mmol/L, P < 0.001) and lower platelet level (206,000/µl vs. 341,000/µl, P < 0.001) compared to the children with normal albumin level. PIM 3 (r = 0.219, P < 0.001) and PRISM III (r = 0.375, P < 0.001) were negatively correlated with serum albumin level, respectively.
CONCLUSIONS
Our results highlight that hypoalbuminemia can be a biomarker of poor prognosis including mortality in the children in ICU.

Keyword

albumins; intensive care units; mortality; pediatrics

MeSH Terms

Adult
Albumins
Blood Platelets
C-Reactive Protein
Child
Critical Care*
Humans
Hypoalbuminemia
Incidence
Intensive Care Units*
Lactic Acid
Medical Records
Mortality
Neutrophils
Pediatrics
Prognosis*
Renal Insufficiency
Retrospective Studies
Serum Albumin*
Shock, Septic
Albumins
C-Reactive Protein
Lactic Acid
Serum Albumin

Figure

  • Figure 1. Albumin level in the first 4 days in intensive care unit in (A) normoalbuminemia group and (B) in hypoalbuminemia group. The box and plots represent mean and standard deviation.

  • Figure 2. Albumin level between non-survival and survival group. Serum albumin level in the survival group was higher than the non-survival group (3.4 g/dl [interquartile range, 3 to 3.8 g/dl] vs. 2.9 g/dl [interquartile range, 2.3 to 3.4 g/dl], P < 0.001). The error bar represents the median and interquartile range for each group.

  • Figure 3. Survival probability according to albumin level. Kaplan-Meier survival estimate for patients according to serum albumin level (albumin <3.5 g/dl vs. albumin ≥3.5 g/dl). This survival curve showed that the hypoalbuminemia group had lower survival probability than the normoalbuminemia group. PICU: pediatric intensive care unit.

  • Figure 4. Receiver operating characteristic curves for mortality between albumin and intensive care unit mortality scoring systems. Area under the receiver operating characteristic curve: PRISM III, 0.850 (95% CI, 0.801 to 0.899); PIM 3, 0.802 (95% CI, 0.747 to 0.858); albumin, 0.702 (95% CI, 0.633 to 0.772). PRISM: Pediatric Risk of Mortality; PIM: Pediatric Index of Mortality; CI: confidence interval.


Reference

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