Hypoalbuminemia as a predictor of mortality in abdominal sepsis

Saucedo-Moreno, Eric M.; Fernández-Rivera, Enrique; Ricárdez-García, José A.

doi:10.24875/cirue.m20000158

Cited by 5 publications

(9 citation statements)

References 7 publications

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“…Acute and chronic reduced levels of serum albumin have both been freely linked to a higher risk of mortality in sepsis. In individuals who develop catastrophic sepsis and organ failure, critical stage low blood albumin is connected to an increased risk of severity and death [32][33][34]. Low albumin levels were a risk factor for overall mortality in patients with acquired bloodstream infections who needed intensive care (OR, 0.34; 95% CI, 0.15-0.76) [35].…”

Section: Discussionmentioning

confidence: 99%

Serum Lactate-Albumin Ratio: Soothsayer for Outcome in Sepsis

Kabra¹,

Acharya²,

Shukla³

et al. 2023

Cureus

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Aim: The aim of this study is to assess the efficacy of the serum lactate/albumin (L/A) ratio as a prognostic marker of sepsis syndrome.Materials and methods: This study was conducted in the Internal Medicine Department at Acharya Vinoba Bhave Rural Hospital with a sample size of 160 cases of sepsis. The serum L/A ratio was calculated on admission and correlated with deaths and morbidity. Statistical analysis was significant if the P-value was less than 0.05.Results: The mean age of patients was 52.83 ± 16.80 years with a male predominance (64.4% vs. 35.6%). The mean L/A ratio was 0.95 ± 0.46. The proportion of discharged subjects and mortality were 58.8% and 41.2%, respectively. The study found that a higher mean L/A ratio (1.1-1.44) was significantly linked to the various variables in the study. Furthermore, a significantly higher median L/A ratio of 1.23 was found in subjects with vasopressor use. The median L/A ratio in the Discharge group and Death group was 0.64 and 1.27, respectively. The area under the receiver operating characteristic (AUROC) curve indicated that accurate diagnostic performance was 0.976 in predicting Death versus Discharge for the L/A ratio.Conclusion: This study found that, compared to lactate and albumin alone, the predictor value of the L/A ratio was outstanding in predicting death and hospital stay (discharge) among sepsis participants, with a sensitivity of 100% and a specificity of 88%.

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Section: Discussionmentioning

confidence: 99%

Serum Lactate-Albumin Ratio: Soothsayer for Outcome in Sepsis

Kabra¹,

Acharya²,

Shukla³

et al. 2023

Cureus

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“…That is, for each 2.5 gm/dl below its normal value, the odds of death increase 24%-56%. [13][14][15][16][17] Recently, with artificial intelligence techniques and machine learning-based models which perform nonlinear analyses, low albumin has been found to be one of the most useful serum biomarkers for predicting survival in critically and chronically ill patients. 17 Albumin, besides being the most important protein for maintaining the colloid-osmotic pressure of plasma, is responsible for carrying many endogenous molecules (antiinflammatory and immunomodulatory molecules) and exogenous molecules (like antibiotics).…”

Section: Discussionmentioning

confidence: 99%

“…17 Albumin, besides being the most important protein for maintaining the colloid-osmotic pressure of plasma, is responsible for carrying many endogenous molecules (antiinflammatory and immunomodulatory molecules) and exogenous molecules (like antibiotics). 14,15 It has important anti-inflammatory and antioxidant properties. 20,21 The group with the lowest albumin in our study, in addition to being associated with microcirculation disorders, had a greater inflammatory response and worse outcomes, like a greater need for MV.…”

Section: Discussionmentioning

confidence: 99%

“…The level of serum albumin has been associated with outcomes in critically ill patients and those with sepsis. [13][14][15][16][17] Due to its negative charge, albumin is electrostatically repelled by the glycocalyx, which helps keep it within the intravascular space. However, in disease states, albumin moves to the interstitial space, and it is unclear whether it can alter capillary Starling forces.…”

Section: Introductionmentioning

confidence: 99%

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The association between hypoalbuminemia and microcirculation, endothelium, and glycocalyx disorders in children with sepsis

Fernández‐Sarmiento,

Hernández‐Sarmiento,

Salazar

et al. 2023

Microcirculation

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ObjectiveThe objective of this study was to evaluate the association between serum albumin levels and microcirculation changes, glycocalyx degradation, and the clinical outcomes of interest.MethodsObservational, prospective study in children with sepsis. The primary outcome was the association between hypoalbuminemia and microcirculation disorders, endothelial activation and glycocalyx degradation using a perfused boundary region (PBR) (abnormal >2.0 μm on sublingual video microscopy) or plasma biomarkers (syndecan‐1, angiopoietin‐2).ResultsA total of 125 patients with sepsis were included. The median age was 2.0 years (IQR 0.5–12.5). Children with hypoalbuminemia had more abnormal microcirculation with a higher PBR (2.16 μm [IQR 2.03–2.47] vs. 1.92 [1.76–2.28]; p = .01) and more 4–6 μm capillaries recruited (60% vs. 40%; p = .04). The low albumin group that had the worst PBR had the most 4–6 μm capillaries recruited (rho 0.29; p < .01), 48% higher Ang‐2 (p = .04), worse annexin A5 (p = 0.03) and no syndecan‐1 abnormalities (p = .21). Children with hypoalbuminemia and a greater percentage of blood volume in their capillaries needed mechanical ventilation more often (56.3% vs. 43.7%; aOR 2.01 95% CI 1.38–3.10: p < .01).ConclusionsIn children with sepsis, an association was found between hypoalbuminemia and microcirculation changes, vascular permeability, and greater endothelial glycocalyx degradation.

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“…Recently, with arti cial intelligence techniques and machine learning-based models which perform non-linear analyses, low albumin has been found to be one of the most useful serum biomarkers for predicting survival in critically and chronically ill patients [17]. Albumin, besides being the most important protein for maintaining the colloid-osmotic pressure of plasma, is responsible for carrying many endogenous molecules (anti-in ammatory and immunomodulatory molecules) and exogenous molecules (like antibiotics) [14,15]. It has important anti-in ammatory and antioxidant properties [20,21].…”

Section: Discussionmentioning

confidence: 99%

The association between hypoalbuminemia and microcirculation, endothelium and glycocalyx disorders in children with sepsis.

Fernández‐Sarmiento

Hernández‐Sarmiento

Salazar

et al. 2023

Preprint

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Background Endothelial inflammation and activation in sepsis can alter albumin synthesis and increase its loss. In these patients, hypoalbuminemia tends to be associated with worse outcomes. The consequences of hypoalbuminemia for the microcirculation of children with sepsis are unknown. We evaluated the association between hypoalbuminemia and microcirculation disorders, endothelial activation and glycocalyx degradation in this group of patients. Methods This was an observational, analytical, prospective cohort study in children with sepsis hospitalized in the pediatric intensive care unit (PICU). The primary outcome was the association between hypoalbuminemia and microcirculation disorders using a perfused boundary region (PBR) > 2.0 µm on sublingual video microscopy or plasma biomarkers (syndecan-1, angiopoietin-2). The secondary outcomes were the association between hypoalbuminemia, microcirculation disorders, the inflammatory response and the need for mechanical ventilation. Results Out of the 1,180 admissions to the PICU during the study period, 125 patients with sepsis were included. The median age was 2.0 years (IQR 0.5–12.5), and the main focus of infection was respiratory. Children with hypoalbuminemia had more abnormal microcirculation with a higher PBR flow corrected (2.16 µm [IQR 2.03–2.47] vs. 1.92 [1.76–2.28]; p = 0.01) and more 4–6 µm capillaries recruited (60% vs. 40%; p = 0.04). The low albumin group that had the worst PBR had the most 4–6 µm capillaries recruited (rho 0.29; p < 0.01), 48% higher Ang-2 (p = 0.04), worse annexin A5 (p = 0.03) and no syndecan-1 abnormalities (p = 0.21). Children with hypoalbuminemia and a greater percentage of blood volume in their capillaries needed mechanical ventilation more often (56.3% vs. 43.7%; aOR 2.01 95% CI 1.38–3.10 :p < 0.01). Children with corrected hypoalbuminemia had improved PBR levels (aOR: 0.17: p5% CI 0.04–0.75; p = 0.02), shorter PICU stays (p = 0.01) and lower mortality (p = 0.02). Conclusions In children with sepsis, an association was found between hypoalbuminemia and microcirculation changes, vascular permeability and greater endothelial glycocalyx degradation. Hypoalbuminemia correction was associated with a recovered glycocalyx, shorter hospital stay and lower mortality.

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Hypoalbuminemia as a predictor of mortality in abdominal sepsis

Cited by 5 publications

References 7 publications

Serum Lactate-Albumin Ratio: Soothsayer for Outcome in Sepsis

Serum Lactate-Albumin Ratio: Soothsayer for Outcome in Sepsis

The association between hypoalbuminemia and microcirculation, endothelium, and glycocalyx disorders in children with sepsis

The association between hypoalbuminemia and microcirculation, endothelium and glycocalyx disorders in children with sepsis.

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