Hypoalbuminemia predicts intensive care need among adult inpatients with community acquired pneumonia: a cross sectional study

Abstract

Introduction: Various scales helped physicians to decide the site of care of pneumonia patients, but had certain limitations. Literature review suggested that serum albumin and B/A ratio predict the site of care but more evidences were required. Therefore, the study was aimed to evaluate the role of serum albumin and B/A ratio in the prediction of intensive care need among patients with community acquired pneumonia.
 Methodology: The cross-sectional analytical study enrolled 134 adult inpatients with pneumonia from Sir Ganga Ram Hospital, Lahore, Pakistan during September 2014 to December 2016. Serum albumin, creatinine and urea levels were estimated; and BUN, B/A ratio and CURB-65 scores were calculated to predict the need of ICU.
 Results: Overall mean age was 50 ± 21 years, and 54.5% patients were females. The patients (19.4%) who required treatment in ICU had significantly lower albumin levels (p = 0.001); elevated BUN levels (p = 0.003), B/A ratio (p = 0.001) and CURB-65 score (p = 0.038); and longer hospital stay (p = 0.002). Hypoalbuminemia showed significant association with the requirement of ICU (OR: 7.956; p = 0.001). The optimal cut-off point of serum albumin to predict ICU need was 3.4 g/dL (50% sensitivity; 89% specificity). Low serum albumin was revealed as a good predictor of requiring treatment in ICU (AUC 0.718).
 Conclusions: Hypoalbuminemia was a good predictor of requiring ICU treatment. Elevated B/A ratio and BUN levels showed significant association with ICU need. Serum albumin estimation before hospitalization might be used independently or additional with established criteria to decide the site of care.

Hypoalbuminemia as Surrogate and Culprit of Infections

“…As shown in patients during the initial phase of bacteremia, after an initial increase in CRP, levels drop over several days, whereas after the sudden drop of serum albumin levels due to trans-capillary leakage, serum levels remain low for a much longer period [ 16 ]. Patients who present with community-acquired bacterial or viral infections are more likely to require intensive care unit (ICU) treatment if serum albumin levels on admission to hospital are low [ 104 , 105 ]. Patients with colorectal cancer who develop infectious complications after laparoscopic surgery have more pronounced postoperative hypoalbuminemia on days 2 and 3 than patients with uncomplicated surgery [ 106 ], suggesting that measurement of serum albumin levels may be helpful in the early recognition of postoperative infection.…”

A new predictive tool consolidating CURB-65 with procalcitonin and albumin to assess short-term mortality in hospitalized elderly patients with infectious disease: A retrospective study of a patient cohort

“…In parallel, for the assessment of prognosis of patients with community-acquired pneumonia, combined use of CURB-65 and PCT, [ 7 – 9 , 11 , 16 , 18 , 19 ] and combined use of CURB-65 and Alb, [ 6 , 10 , 12 – 14 , 21 , 27 ] have been widely applied. Alb is known to be a prognostic factor for elderly people.…”

“…Not only bacteria-derived substances, endotoxin, but also physiologically intracellular and extracellular-released substances triggered the production of PCTs by recognizing substance derived from bacterial pathogen-associated molecular patterns or damage associated molecular patterns, but non-physiological apoptosis of the cells results in the release of material with similar molecular patterns to enhance the production of PCT. [25,26] In parallel, for the assessment of prognosis of patients with community-acquired pneumonia, combined use of CURB-65 and PCT, [7][8][9]11,16,18,19] and combined use of CURB-65 and Alb, [6,10,[12][13][14]21,27] have been widely applied. Alb is known to be a prognostic factor for elderly people.…”

“…The CURB-65 was also applied to predict 30 day mortality in patients admitted to a general internal medicine ward. [15] Several studies have also suggested biochemical parameters such as procalcitonin (PCT) [7,8,11,[16][17][18][19] and albumin (Alb) [6,10,12,17,[20][21][22] as valuable indices to predict health status and quality of life of hospitalized elderly patients to a certain extent. Other than CURB-65, qSOFA also exists as an index of organ damage.…”

“…For disease severity assessment, CURB-65 score was first proposed by Lim et al, [5] and has been widely applied to assess the prognosis of community-acquired pneumonia. [6][7][8][9][10][11][12][13][14] CURB-65 does not include nutritional or personal care assistance and Medicine is a convenient indicator which stands for 5 easily measurable parameters (confusion, raised urea, tachypnea, hypotension and age ≥ 65). The CURB-65 was also applied to predict 30 day mortality in patients admitted to a general internal medicine ward.…”