Serum Albumin Is an Independent Predictor of Clinical Outcomes in Critically Ill Children

Serum Albumin Is an Independent Predictor of Clinical Outcomes in Critically Ill Children

Author Leite, Heitor Pons Autor UNIFESP Google Scholar
Silva, Alessandra Vaso Rodrigues da Autor UNIFESP Google Scholar
Iglesias, Simone Brasil de Oliveira Autor UNIFESP Google Scholar
Nogueira, Paulo Cesar Koch Autor UNIFESP Google Scholar
Abstract Objectives: Serum albumin is a strong biomarker of disease severity and prognosis in adult patients. In contrast, its value as predictor of outcome in critically ill children has not been established. We aimed to determine whether admission hypoalbuminemia is associated with outcome in a general pediatric population of critically ill patients, taking into account the inflammatory response, disease severity, and nutritional status of the patient. Design: Analysis of prospectively collected database. Setting: PICU of a teaching hospital. Patients: Two hundred seventy-one patients consecutively admitted. Neonates, patients with chronic liver or kidney disease, inborn errors of metabolism, those who received prior administration of albumin solution, and readmissions were excluded. Measurements and Main Results: Outcome variables were 60-day mortality, probability of ICU discharge at 60 days, and ventilator-free days. Potential exposure variables for the outcome were sex, age, nutritional status, albumin, C-reactive protein and serum lactate at admission, and Pediatric Index of Mortality 2 score. Admission hypoalbuminemia was present in 64.2% of patients. After adjustment for confounding factors, only serum lactate, Pediatric Index of Mortality 2 score, and serum albumin were associated with higher mortality: the increase of 1.0 g/dL in serum albumin at admission resulted in a 73% reduction in the hazard of death (hazard ratio, 0.27; 95% CI, 0.14-0.51; p < 0.001). The increase of 1 g/dL in serum albumin was also independently associated with a 33% rise in the probability of ICU discharge (subhazard ratio, 1.33; 95% CI, 1.07-1.64; p = 0.008) and increased ventilator-free-days (odds ratio, 1.86; 95% CI, 0.56-3.16; p = 0.005). Conclusions: Hypoalbuminemia at admission to a PICU is associated with higher 60-day mortality, longer duration of mechanical ventilation, and lower probability of ICU discharge. These associations are independent of the magnitude of inflammatory response, clinical severity, and nutritional status.
Keywords assessment
patient outcomes
intensive care units
length of stay
mechanical ventilation
xmlui.dri2xhtml.METS-1.0.item-coverage Philadelphia
Language English
Sponsor Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (National Council for Scientific and Technological Development)
Grant number CNPq: 124479/2013-8
Date 2016
Published in Pediatric Critical Care Medicine. Philadelphia, v. 17, n. 2, p. E50-E57, 2016.
ISSN 1529-7535 (Sherpa/Romeo, impact factor)
Publisher Lippincott Williams & Wilkins
Extent E50-E57
Access rights Closed access
Type Article
Web of Science ID WOS:000369673000004

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