Prognostic Role of Serum Albumin in Predicting 30-Day Mortality in Patients with Infections in Emergency Department: A Prospective Study

Abstract

Background: Infections in emergency departments (EDs) are insidious clinical conditions characterised by high rates of hospitalisation and mortality in the short-to-medium term. The serum albumin, recently demonstrated as a prognostic biomarker in septic patients in intensive care units, could be an early marker of severity upon arrival of infected patients in the ED. Aim: To confirm the possible prognostic role of the albumin concentration recorded upon arrival of patients with infection. Methods: A prospective single-centre study was performed in the ED of the General Hospital of Merano, Italy, between 1 January 2021 and 31 December 2021. All enrolled patients with infection were tested for serum albumin concentration. The primary outcome measure was 30-day mortality. The predictive role of albumin was assessed by logistic regression and decision tree analysis adjusted for Charlson comorbidity index, national early warning score, and sequential organ failure assessment (SOFA) score. Results: 962 patients with confirmed infection were enrolled. The median SOFA score was 1 (0–3) and the mean serum albumin level was 3.7 g/dL (SD 0.6). Moreover, 8.9% (86/962) of patients died within 30 days. Albumin was an independent risk factor for 30-day mortality with an adjusted hazard ratio of 3.767 (95% CI 2.192–6.437), p < 0.001. Decision tree analysis indicated that at low SOFA scores, albumin had a good predictive ability, indicating a progressive mortality risk reduction in concentrations above 2.75 g/dL (5.2%) and 3.52 g/dL (2%). Conclusions: Serum albumin levels at ED admission are predictive of 30-day mortality in infected patients, showing better predictive abilities in patients with low-to-medium SOFA scores.

The Clinical Utility of Albumin with Sequential Organ Failure Assessment (SOFA) in Improving 30-Day Mortality Prediction in Patients with Infection in the Emergency Department

“…This observational, single-center study was performed between 1 January and 31 December 2021 at the ED of the Merano Hospital (Italy; 53,000 accesses in 2021). This was a secondary analysis of data collected in a previous study performed at the same ED [14].…”

“…Currently, there is no clear definition for an 'infected patient' at the access in the ED [14]. For this reason, the choice of considering patients affected by an infection and to include them in the study was made by the ED physician.…”

“…Serum albumin levels have been recently found to predict the severity of sepsis [8,14]. The decrease in albumin, which is associated with increased mortality, appears to correlate with the presence and severity of inflammation-induced microvascular changes that contribute to tissue hypoxia prior to the development of organ damage [8,14,15].…”

“…Serum albumin levels have been recently found to predict the severity of sepsis [8,14]. The decrease in albumin, which is associated with increased mortality, appears to correlate with the presence and severity of inflammation-induced microvascular changes that contribute to tissue hypoxia prior to the development of organ damage [8,14,15]. Patients with infections who present in the ED with a low albumin level, particularly those who are hemodynamically stable, may be at a higher evolutionary risk of death [8,14,15].…”

“…The decrease in albumin, which is associated with increased mortality, appears to correlate with the presence and severity of inflammation-induced microvascular changes that contribute to tissue hypoxia prior to the development of organ damage [8,14,15]. Patients with infections who present in the ED with a low albumin level, particularly those who are hemodynamically stable, may be at a higher evolutionary risk of death [8,14,15]. As a result, the prognostic role of this early indicator used together with the SOFA score may improve its suitability for predicting late-stage organ damage, complementing its determination of early tissue damage to improve overall prognostic prediction in patients with infections.…”