Association of serum albumin levels with inflammation and clinical outcomes in children with acute bronchiolitis.

Abstract

Objective: To evaluate if hypoalbuminemia on admission predict disease severity in children with acute bronchiolitis (AB). Working hypothesis: Hypoalbuminemia is associated with worse outcome in infants with AB. Study design: Single-centre prospective cohort study. Patient-subject selection : Infants aged <12 month-old with AB. Methodology: Serum albumin levels were determined within the first 24 hours upon inclusion. The primary outcome was the need of pediatric intensive care unit (PICU) admission. Results: We enrolled 90 cases of AB. Serum albumin was independently associated with C-Reactive protein levels (CRP) (r s =-0,28; p=0.002). Fourteen (15.5%) cases required PICU admission. They presented lower serum albumin levels (3.7 (0.11) vs 4 (0.5) g/dl; p=0.034) regarding those patients without severe illness. In the multivariate logistic regression analysis, hypoalbuminemia was independently associated with a higher risk of severe illness (adjusted Odds Ratio 4.1 (1.2-85); p=0.032). The area under the ROC curve for serum albumin to predict adverse outcome was 0.70 (95% Confidence interval of 0.59-0.79). A cutoff point of 3.5 g/dl presented a sensitivity of 0.71, specificity of 0.68, positive predictive value of 0.29, and negative predictive value of 0.92. Conclusion:Low serum albumin levels at admission are significantly associated with higher PICU admission rates in infants with AB. The inflammatory response could play a key role in the occurrence of hypoalbuminemia in AB.

Value of Serum Albumin Level in Assessment of Severity of Acute Bronchiolitis Assessed by Modified Tal Score

“…Our results were partially agreed with a study which reported that serum albumin displayed a significant correlation with CRP (r s =-0.27; p =0.008), PCO2 (r s =-0.32; p=0.003), and HCO3 (r=-0.24; p=0.029) levels. However, in contrast to our results they observed that serum albumin level had significant negative correlations with age (r s =0.50; p <0.001) and weight for age percentile (r s =0.33; p= 0.002) (7).…”

“…The patients with serum albumin <3.5 g/dl presented a five-fold risk of PICU admission (OR 5.5 (CI95% 1-55-19); p =0.008). After adjusting for potential confounders (age, weight for age, presence of comorbidity, BROSJOD score, respiratory acidosis and CRP) in a multivariate logistic regression analysis, serum albumin level less than 3.5 g/dl remained independently with a higher risk of severe AB (a OR 4.1 (1.2-24); p = 0.032) (7).…”

“…Our results were in agreement with a study revealed that the ROC curve for serum albumin in predicting severe AB was generated, yielding an AUC of 0.70 (95% CI 0.59-0.79). A cut-off point of 3.5 g/dl presented a sensitivity of 71%, specificity of 68%, positive predictive value of 0.29, and negative predictive value of 0.92 (7).…”

“…During severe AB a reduced energetic intake, impaired nutritional status and an inflammation with a cytokine-mediated acute phase response can coexist, leading to lowered levels of serum albumin. However, the association between albumin and AB severity has been little investigated in this setting (7).…”