Serum Albumin and C-Reactive Protein as Predictors of Adverse Outcomes in Critically Ill Children: A Prospective Observational Pilot Study

Bhandarkar, Neha; Save, Sushma; Bavdekar, Sandeep B; Sisodia, Pankhuri; Desai, Saumil

doi:10.1007/s12098-019-02934-3

Cited by 5 publications

(5 citation statements)

References 5 publications

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“…Park et al 27 concluded that the CPR/ALB ratio was an independent predictor of 28‐day mortality in critically ill children, with an AUC of the ROC curve of 0.594 and the best‐estimated cut‐off point for mortality on 34. Bhandarkar et al 28 reported that a combination of hypoalbuminemia and raised CRP at admission have better sensitivity and specificity than either of them alone for predicting unfavorable prognosis in 100 PICU patients. To our knowledge, this is the first study assessing the CRP/ALB ratio predicting ARS and PICU admission in bronchiolitis.…”

Section: Discussionmentioning

confidence: 99%

Routine laboratory test to assess the need of respiratory support in acute bronchiolitis

Rodríguez-González

Estepa-Pedregosa

Estalella-Mendoza

et al. 2022

Pediatric Pulmonology

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Background and Objectives: Accurate and readily available biomarkers to predict the clinical course of bronchiolitis would enable enhanced decision-making in this setting. We explored the relationship of several biochemical parameters available at the pediatric emergency care setting with the need of advanced respiratory support (ARS): continuous positive airway pressure (CPAP), biphasic positive airway pressure (BiPAP), or invasive mechanical ventilation (MV) in bronchiolitis.Methods: Single-center, prospective, observational, including infants aged less than 12 months diagnosed with acute bronchiolitis at the Pediatric Emergency Department. Determination of plasmatic values of several laboratory tests was performed at the time of hospital admission. Multivariate logistic analysis identified independent predictors for need of ARS.Results: From October 1, 2018 to May 1, 2020, we recruited 149 infants (58% males; median age of 1 [0.5-2.5] month). Thirty-seven (25%) cases required ARS.After adjusting by age, bacterial superinfection, and comorbidities in the multivariate analysis, only higher levels of glycemia (p = 0.001), C-reactive protein (CRP) (p = 0.028), CRP/albumin ratio (p = 0.032), and NT-proBNP (p = 0.001) remained independently associated with ARS. These biomarkers reached moderate prediction accuracy with area under the curve of receiver operator curve curves ranging from 0.701 to 0.830 (p = 0.001). All they presented relatively high specificity (0.75-0.84) and negative predictive values (0.77-0.89) with low sensitivity and positive predictive values. They also correlated significantly with length of stay hospitalization (p = 0.001). Conclusion:Increased plasmatic levels of CRP, CRP/albumin ratio, glycemia, and NT-proBNP at hospital admission are associated with the need for ARS in infants with acute bronchiolitis.

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Section: Discussionmentioning

confidence: 99%

Routine laboratory test to assess the need of respiratory support in acute bronchiolitis

Rodríguez-González

Estepa-Pedregosa

Estalella-Mendoza

et al. 2022

Pediatric Pulmonology

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“…In a prospective observational study of 100 critically ill children on a pediatric intensive care unit (PICU), a high CRP/ALB ratio predicted an unfavorable prognosis with adverse outcome (i.e. organ failure and/or death) [10].…”

Section: Discussionmentioning

confidence: 99%

“…More recently, it has been demonstrated that a high CRP/ALB ratio is indicative of worse outcome (i.e. organ failure and/or death) in critically ill children on a pediatric intensive care unit [10]. The aim of this study was to investigate if the serum CRP/ALB ratio has a prognostic value in predicting surgical intervention and mortality in neonates with NEC.…”

Section: Introductionmentioning

confidence: 99%

C-reactive protein/albumin ratio is a prognostic indicator for predicting surgical intervention and mortality in neonates with necrotizing enterocolitis

et al. 2021

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Purpose The role of hypoalbuminemia and raised C-reactive protein (CRP) levels in predicting critical prognosis has been described extensively in adult literature. However, there are limited studies in pediatrics, particularly neonates. The CRP/albumin (CRP/ALB) ratio is often associated with higher mortality, organ failure and prolonged hospital stay. We hypothesized that the serum CRP/ALB ratio has a prognostic value in predicting surgery and mortality in neonates with necrotizing enterocolitis (NEC). Methods Retrospective review of all neonates with clinical and radiological evidence of non-perforated NEC that were treated in a tertiary-level referral hospital between 2009 and 2018. General patient demographics, laboratory parameters and outcomes were recorded. Receiver operating characteristics analysis was performed to evaluated optimal cut-offs and area under the curve (AUC) with 95% confidence intervals (CI). Results A total of 191 neonates were identified. Of these, 103 (53.9%) were born at ≤ 28 weeks of gestation and 101 (52.9%) had a birth weight of ≤ 1000 g. Eighty-four (44.0%) patients underwent surgical intervention for NEC. The overall survival rate was 161/191 (84.3%). A CRP/ALB ratio of ≥ 3 on day 2 of NEC diagnosis was associated with a statistically significant higher likelihood for surgery [AUC 0.71 (95% CI 0.63–0.79); p < 0.0001] and mortality [AUC 0.66 (95% CI 0.54–0.77); p = 0.0150], respectively. Conclusions A CRP/ALB ratio of ≥ 3 on day 2 is indicative of a critical pathway in neonates with radiologically confirmed, non-perforated NEC. This could be used as an additional criterion to guide parental counselling in NEC for surgical intervention and mortality.

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“…Serum albumin is considered as a marker of disease severity in critically ill adult patients, with low serum albumin concentrations being reported in 30%-50% of cases 12,13 . Some studies have investigated the incidence and the prognostic value of hypoalbuminemia in critically ill children, reporting a higher incidence (60% approximately) in cases requiring PICU admission 11,[16][17][18][19][20][21][22] . In our study, hypoalbuminemia, defined as serum levels less than 3.5 g/dl, was observed in approximately 15% of cases of AB at presentation.…”

Section: Discussionmentioning

confidence: 99%

“…The presence of hypoalbuminemia has been previously shown as a significant marker of mortality and increased stay in children admitted to pediatric intensive care unit 11,[16][17][18][19][20][21][22] , but to our knowledge this is the second study that have investigated the role of hypoalbuminemia as biomarker for severity in children with AB. Mansbach et al studied 1016 infants with AB and found that those cases of AB presenting with hypoalbuminemia had a four-fold risk to develop apnea during hospitalization 14 .…”

Section: Discussionmentioning

confidence: 99%

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

Rodríguez-González¹,

Rodríguez-Campoy²,

Estalella-Mendoza³

et al. 2020

Preprint

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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.

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Serum Albumin and C-Reactive Protein as Predictors of Adverse Outcomes in Critically Ill Children: A Prospective Observational Pilot Study

Cited by 5 publications

References 5 publications

Routine laboratory test to assess the need of respiratory support in acute bronchiolitis

Routine laboratory test to assess the need of respiratory support in acute bronchiolitis

C-reactive protein/albumin ratio is a prognostic indicator for predicting surgical intervention and mortality in neonates with necrotizing enterocolitis

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

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