Hypoalbuminemia and risk of death in critically ill patients in a polyvalent unit
Keywords:
hypoalbuminemia, APACHE II, risk of death, intensive care, critical patient.Abstract
Introduction: Hypoalbuminemia can develop in the first hours after an acute illness, and is closely related to an active inflammatory state, regardless of the patient's nutritional status. It has been associated with hospital mortality in patients with post-surgical complications, patients with sepsis and trauma.
Objective: To evaluate the association between hypoalbuminemia level and the risk of mortality in critically ill patients in a polyvalent unit.
Methods: Observational, descriptive, prospective, case series study, with 216 patients admitted to the unit. Demographic, clinical, and laboratory variables were analyzed and the APACHE II prognostic score was applied. Albumin concentration is calculated on admission and hypoalbuminemia is classified as mild (30-35 g/L) and moderate/severe (≤ 30 g/L).
Results: In the study, 28 patients died, which represented 13% of the total number of patients admitted. Albumin levels were low in 118 patients (54.6%), and of these 66 patients (56%) were classified as hypoalbuminemia moderate/severe, with albumin values below 30 g/L. Patients with moderate-severe hypoalbuminemia had a higher risk of death (23.5%) than those patients with levels classified as mild (15.3%), a statistically significant difference (p= 0.034); and in the group of patients with moderate-severe hypoalbuminemia, 67% died, in relation to 33% of patients with levels classified as mild.
Conclusions: Moderate-severe hypoalbuminemia is associated with mortality risk, regardless of admission diagnosis.
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References
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24. Rodríguez ET, González JC, Cabrera JO, Algas LA. Factores pronósticos de fallo orgánico y muerte en pacientes con peritonitis difusa secundaria. Rev Cubana Med Intens Emerg. 2018 [acceso: 28/12/2019]; 17(4):1-18. Disponible en: http://www.revmie.sld.cu/index.php/mie/article/view/424/601
25. Sitar ME, Aydin S, Cakatay U. Human serum albumin and its relation with oxidative stress. Clin Lab. 2013 [acceso: 20/07/2020]; 59(9-10):945-52. Disponible en: https://pubmed.ncbi.nlm.nih.gov/24273915/
26. Vahedi A, Lotfinia I, Sad RB, Halimi M, Baybordi H. Relationship between admission hypoalbuminemia and inhospital mortality in acute stroke. Pak J Biol Sci. 2011; 14(2):118-22. DOI: 10.3923/pjbs.2011.118.122
27. Sung J, Bochicchio GV, Joshi M, Bochicchio K, Costas A, Tracy K, et al. Admission serum albumin is predictive of outcome in critically ill trauma patients. Am Surg. 2004 [acceso: 29/12/2019]; 70(12):1099-102. Disponible en: https://pubmed.ncbi.nlm.nih.gov/15663053/
28. Cheon JH, Kim JS, Ko SJ, Ye BD, Kim SG, Jung HC, et al. Risk factors for upper gastrointestinal rebleeding in critically ill patients. Hepatogastroenterology. 2007 [acceso: 30/12/2019]; 54(75) (75):766-9. Disponible en: https://pubmed.ncbi.nlm.nih.gov/17591058/
2. Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2017; 36(1):49-64. DOI: 10.1016/j.clnu.2016.09.004
3. Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: Pathogenesis and Clinical Significance. JPEN J Parenter Enteral Nutr. 2019; 43(2):181-93. DOI: 10.1002/jpen.1451
4. Trujillo Ramírez N, López Reséndiz SM, Méndez Reyes R, Villagómez Ortiz AJ, Rosas Barrientos JV. Índice lactato/albúmina como predictor de mortalidad en sepsis y choque séptico. Med. Crít Crít. 2018 [acceso: 06/10/2020]; 32(3):136-40. Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S2448-89092018000300136&lng=es
5. Godínez A, Correa A, Enríquez D, Pérez S, López S, Gracida N. ¿Es la albúmina un predictor de gravedad y de mortalidad en pacientes con sepsis abdominal? Revista Cir Cir. 2019 [acceso: 18/07/2020]; 87:485-489. Disponible en: https://www.medigraphic.com/pdfs/circir/cc-2019/cc195a.pdf
6. López Lázaro AB, Aguilar Murillo GM, Muñoz Neciosup AP, Goicochea Rios E. Hipoalbuminemia como predictor de mortalidad de sepsis por COVID-19. Rev. Fac. Med. Hum. 2021; 21(1):12-18. DOI: 10.25176/RFMH.v21i1.3437
7. Dubois M, Orellana-Jiménez C, Melot C, De Backer D, Berre J, Leeman M, et al. Albumin administration improves organ function in critically ill hipoalbuminemic patients: A prospective, randomized controlled, pilot study. Crit Care Med. 2006; 34:2536-40. DOI: 10.1097/01.CCM.0000239119.57544.0C
8. Cochrane Injuries Group Albumin Reviewers. Human albumin administration in critically ill patients: systematic review of randomized controlled trials. BMJ. 1998 [acceso: 20/09/2020]; 317:235-40. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC28613/pdf/235.pdf
9. Sebai MA, Kerezoudis P, Alvi MA, Yoon JW, Spinner RJ, Bydon M. Need for arthrodesis following facetectomy for spinal peripheral nerve sheath tumors: an institutional experience and review of the current literature. J Neurosurg Spine. 2019; 31(1):112-22. DOI: 10.3171/2019.1.SPINE181057
10. Rodríguez ET, González JC, Cabrera JO, Algas LA. Factores pronósticos de fallo orgánico y muerte en pacientes con peritonitis difusa secundaria. Rev Cub Med Intens Emerg. 2018 [acceso: 28/12/2019]; 17(4):1-18. Disponible en: http://www.revmie.sld.cu/index.php/mie/article/view/424/601
11. Man C, Wang M, Yin G, Huang J, Cheng W, Wu X, Liu L, et al. Clinical features of 47 secondary hemophagocytic lymphohistiocytosis patients complicated with capillary leak syndrome. Int J Hematol. 2021; 113(2):263-70. DOI: 10.1007/s12185-020-03011-8
12. Uhing MR. The albumin controversy. Clin Perinatol. 2004; 31(3):475-88. DOI: 10.1016/j.clp.2004.03.018
13. Hernández Rodríguez J. Clinical aspects related to the severe acute respiratory syndrome (SARS-CoV-2). Rev Haban Cienc Méd. 2020 [acceso: 06/10/2020]; 19(Suppl 1): e3279. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1729-519X2020000400003&lng=es
14. Saucedo Moreno EM, Fernández-rivera E, Ricardez-García JA. Hipoalbuminemia como predictor de mortalidad en sepsis de origen abdominal. Cirugía y Cirujanos. 2020 [acceso: 14/10/2020]; 88(4):484-5 Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S2444-054X2020000400481&lng=es
15. Godínez A, Correa A, Enríquez D, Pérez S, López S, Gracida N. ¿Es la albúmina un predictor de gravedad y de mortalidad en pacientes con sepsis abdominal? Revista Cir Cir. 2019 [acceso: 18/07/2020]; 87:485-9. Disponible en: https://www.medigraphic.com/pdfs/circir/cc-2019/cc195a.pdf
16. Akirov A, Masri-Iraqi H, Atamna A, Shimon L. Low Albumin Levels Are Associated with Mortality Risk in Hospitalized Patients. The American Journal of Medicine. 2017; 30(12):1465.e11-1465.e19. DOI: 10.1016/j.amjmed.2017.07.020
17. López-Lázaro AB, Aguilar-Murillo GM, Muñoz-Neciosup AP, Goicochea-Rios E. Hipoalbuminemia como predictor de mortalidad de sepsis por COVID-19. Hospital II CHOCOPE, 2020. Rev. Fac. Med. Hum. 2021; 21(1):12-18. DOI: 10.25176/RFMH.v21i1.3437
18. Bteich M. An overview of albumin and alpha-1-acid glycoprotein main characteristics: highlighting the roles of amino acids in binding kinetics and molecular interactions. Heliyon. 2019; 5(11):e02879. DOI: 10.1016/j.heliyon.2019.e02879
19. Vincent JL, Navickis. RJ, And Wilkes MM. Morbidity in hospitalized patients receiving human albumin: A metaanalysis of randomized, controlled trials. Crit Care Med. 2009; 32(10):2029-38; 32(10):2029-38. DOI: 10.1097/01.ccm.0000142574.00425.e9
20. Yin M, Si L, Qin W, Li C, Zhang J, Yang H, et al. Predictive value of serum albumin level for the prognosis of severe sepsis without exogenous human albumin administration. J Intensive Care Med. 2018; 33(12):687-94 ; 32(10):2029-38. DOI: 10.1177/0885066616685300
21. Jellinge M, Henriksen D, Hallas P, Brabrand M. Hypoalbuminemia is a strong predictor of 30-day all-cause mortality in acutely admitted medical patients: a prospective, observational, cohort stud. PLoS One. 2014;: 9(8):e1059839(8):e105983. DOI: 10.1371/journal.pone.0105983
22. Liñán-Ponce J, Véliz-Vilcapoma F. Características clínicas de los pacientes con sepsis severa admitidos a una Unidad de Cuidados Intensivos. Rev Soc Perú Med Interna. 2008; 21(4):139. DOI: 10.36393/spmi.v21i4.303
23. Mohamed AA, Essam A. Disturbed fluid responsiveness and lactate/pyruvate ratio as predictors for mortality of septic shock patients. Egyptian Journal of Anaesthesia. 2016; 32(4):451-61. DOI: 10.1016/j.egja.2016.04.009
24. Rodríguez ET, González JC, Cabrera JO, Algas LA. Factores pronósticos de fallo orgánico y muerte en pacientes con peritonitis difusa secundaria. Rev Cubana Med Intens Emerg. 2018 [acceso: 28/12/2019]; 17(4):1-18. Disponible en: http://www.revmie.sld.cu/index.php/mie/article/view/424/601
25. Sitar ME, Aydin S, Cakatay U. Human serum albumin and its relation with oxidative stress. Clin Lab. 2013 [acceso: 20/07/2020]; 59(9-10):945-52. Disponible en: https://pubmed.ncbi.nlm.nih.gov/24273915/
26. Vahedi A, Lotfinia I, Sad RB, Halimi M, Baybordi H. Relationship between admission hypoalbuminemia and inhospital mortality in acute stroke. Pak J Biol Sci. 2011; 14(2):118-22. DOI: 10.3923/pjbs.2011.118.122
27. Sung J, Bochicchio GV, Joshi M, Bochicchio K, Costas A, Tracy K, et al. Admission serum albumin is predictive of outcome in critically ill trauma patients. Am Surg. 2004 [acceso: 29/12/2019]; 70(12):1099-102. Disponible en: https://pubmed.ncbi.nlm.nih.gov/15663053/
28. Cheon JH, Kim JS, Ko SJ, Ye BD, Kim SG, Jung HC, et al. Risk factors for upper gastrointestinal rebleeding in critically ill patients. Hepatogastroenterology. 2007 [acceso: 30/12/2019]; 54(75) (75):766-9. Disponible en: https://pubmed.ncbi.nlm.nih.gov/17591058/
Published
2023-03-09
How to Cite
1.
Quispe Alarcón GS, Díaz Lara Y, Soneira Pérez J, González García S, Berty Gutiérrez H. Hypoalbuminemia and risk of death in critically ill patients in a polyvalent unit. Rev Cubana Med Milit [Internet]. 2023 Mar. 9 [cited 2025 May 9];52(1):e02302319. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/2319
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