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VOLUME 18 , ISSUE 9 ( September, 2014 ) > List of Articles

RESEARCH ARTICLE

Hypoalbuminemia in critically sick children

Sunit Singhi, Lokesh K. Tiwari, M. Jayashree, Arun K. Baranwal

Keywords : Critically sick children, hypoalbuminemia, pediatric intensive care unit

Citation Information : Singhi S, Tiwari LK, Jayashree M, Baranwal AK. Hypoalbuminemia in critically sick children. Indian J Crit Care Med 2014; 18 (9):565-569.

DOI: 10.4103/0972-5229.140143

License: CC BY-ND 3.0

Published Online: 01-09-2014

Copyright Statement:  Copyright © 2014; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Context: There is a paucity of data evaluating serum albumin levels and outcome of critically ill-children admitted to intensive care unit (ICU). Aims: The aim was to study frequency of hypoalbuminemia and examine association between hypoalbuminemia and outcome in critically ill-children. Settings and Design: Retrospective review of medical records of 435 patients admitted to 12 bedded pediatric ICU (PICU). Materials and Methods: Patients with hypoalbuminemia on admission or any time during PICU stay were compared with normoalbuminemic patients for demographic and clinical profile. Effect of albumin infusion was also examined. Odds ratio and 95% confidence interval were calculated using SPSS 16. Results: Hypoalbuminemia was present on admission in 21% (92 of 435) patients that increased to 34% at the end of 1 st week and to 37% (164 of 435) during rest of the stay in PICU. Hypoalbuminemic patients had higher Pediatric Risk of Mortality scores (12.9 vs. 7.5, P < 0.001) and prolonged PICU stay (13.8 vs. 6.7 days, P < 0.001); higher likelihood of respiratory failure requiring mechanical ventilaton (84.8% vs. 28.8%, P < 0.001), prolonged ventilatory support, progression to multiorgan dysfunction syndrome (87.8% vs. 16.2%) and risk of mortality (25.6% vs. 17.7%). Though, the survivors among recipients of albumin infusion had significantly higher increase in serum albumin level (0.76 g/dL, standard deviation [SD] 0.54) compared with nonsurvivors (0.46 g/dL, SD 0.44; P = 0.016), albumin infusion did not reduce the risk of mortality. Conclusions: Hypoalbuminemia is a significant indicator of mortality and morbidity in critically sick children. More studies are needed to define role of albumin infusion in treatment of such patients.


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  1. McPherson RA, Pincus MR. Specific protiens. In: McPherson RA, Pincus MR, editors. Henry′s Clinical Diagnosis and Management by Laboratory Methods. 21 st ed. Philadelphia: Saunders Elsevier; 2007. p. 511-9.
  2. Sung J, Bochicchio GV, Joshi M, Bochicchio K, Costas A, Tracy K, et al. Admission serum albumin is predicitve of outcome in critically ill trauma patients. Am Surg 2004;70:1099-102.
  3. Nicholson JP, Wolmarans MR, Park GR. The role of albumin in critical illness. Br J Anaesth 2000;85:599-610.
  4. Horowitz IN, Tai K. Hypoalbuminemia in critically ill children. Arch Pediatr Adolesc Med 2007;161:1048-52.
  5. Fleck A, Raines G, Hawker F, Trotter J, Wallace PI, Ledingham IM, et al. Increased vascular permeability: A major cause of hypoalbuminaemia in disease and injury. Lancet 1985;1:781-4.
  6. Rady MY, Ryan T. Perioperative predictors of extubation failure and the effect on clinical outcome after cardiac surgery. Crit Care Med 1999;27:340-7.
  7. Goldwasser P, Feldman J. Association of serum albumin and mortality risk. J Clin Epidemiol 1997;50:693-703.
  8. Vincent JL, Dubois MJ, Navickis RJ, Wilkes MM. Hypoalbuminemia in acute illness: Is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials. Ann Surg 2003;237:319-34.
  9. Zimmerman JE, Kramer AA, McNair DS, Malila FM. Acute Physiology and Chronic Health Evaluation (APACHE) IV: Hospital mortality assessment for today′s critically ill patients. Crit Care Med 2006;34:1297-310.
  10. Durward A, Mayer A, Skellett S, Taylor D, Hanna S, Tibby SM, et al. Hypoalbuminaemia in critically ill children: Incidence, prognosis, and influence on the anion gap. Arch Dis Child 2003;88:419-22.
  11. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992;20:864-74.
  12. Cengiz O, Kocer B, Sürmeli S, Santicky MJ, Soran A. Are pretreatment serum albumin and cholesterol levels prognostic tools in patients with colorectal carcinoma? Med Sci Monit 2006;12:CR240-7.
  13. Doweiko JP, Nompleggi DJ. The role of albumin in human physiology and pathophysiology, Part III: Albumin and disease states. JPEN J Parenter Enteral Nutr 1991;15:476-83.
  14. Rodoman GV, Shalaeva TI, Dobretsov GE, Naumov EK, Obolenskii VN. Serum albumin in systemic inflammatory reaction syndrome. Anesteziol Reanimatol 2006;(2):62-4.
  15. Kohli U, Kuttiat VS, Lodha R, Kabra SK. Profile of childhood poisoning at a tertiary care centre in North India. Indian J Pediatr 2008;75:791-4.
  16. Murray MJ, Marsh HM, Wochos DN, Moxness KE, Offord KP, Callaway CW. Nutritional assessment of intensive-care unit patients. Mayo Clin Proc 1988;63:1106-15.
  17. Yap FH, Joynt GM, Buckley TA, Wong EL. Association of serum albumin concentration and mortality risk in critically ill patients. Anaesth Intensive Care 2002;30:202-7.
  18. Lee YW, Ahn JY, Han IB, Chung YS, Chung SS, Kim NK. The influence of hypoalbuminemia on neurological outcome in patients with subarachnoid hemorrhage. Korean J Cerebrovasc Surg 2005;7:109-12.
  19. Abubakar S, Sabir A, Ndakotsu M, Imam M, Tasiu M. Low admission serum albumin as prognostic determinant of 30-day case fatality and adverse functional outcome following acute ischemic stroke. Pan Afr Med J 2013;14:53.
  20. Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004;350:2247-56.
  21. Dubois MJ, Orellana-Jimenez C, Melot C, De Backer D, Berre J, Leeman M, et al. Albumin administration improves organ function in critically ill hypoalbuminemic patients: A prospective, randomized, controlled, pilot study. Crit Care Med 2006;34:2536-40.
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