The Risk Factors And Prognosis Of Hypoalbuminemia In Septic Patients

Objective:To investigate the risk factors of hypoalbuminemia and the severity and prognosis of different serum albumin levels in septic patients.Methods and materials:86 patients with sepsis or septic shock in the Intensive care unit(ICU)and Intensive care unit of emergency department(EICU)of The First Affiliated Hospital of Dalian Medical University from January 2014 to October 2016 were performed in this retrospective study.Serum albumin was the mean value of serum albumin which admitted in ICU within 24h.These patients were divided into two groups:non-hypoalbuminemia group and hypoalbuminemia group,datas were included univariate analysis and multivariate regression analysis to investigate the risk factors of hypoalbuminemia.The patients were divided into four groups according to serum albumin concentration:group A(≥30 g/L),group B(25-29.9 g/L),group C(20-24.9 g/L),group D(≤19.9 g/L),the primary end point indicators were ICU mortality,morbidity of MODS,the secondary end point indicators were vasopressors administration incidences,ICU stays,mechanical ventilation cases and duration,continuous renal replacement therapy cases,investigated the influence of different serum albumin concentration to state of illness and prognosis.Meanwhile the patients were divided into two groups according to the clinical outcome:survival group and death group,then the clinical indicators and prognosis of each groups were included in univariate analysis and multivariate regression analysis to investigate the risk factors of prognosis.Results:The study included a total of 86 patients with sepsis or septic shock,29 patients died,the mortality was 33.72%,51 patients complicated with Multiple organ dysfunction syndrome,the morbidity was 59.30%.The hypoalbuminemia group included 63 patients(73.26%),25 patients died,the mortality was 39.68%,41 patients complicated with Multiple organ dysfunction syndrome,the morbidity was 65.08%,The non-hypoalbuminemia group included 23 patients(26.74%),4 patients died,the mortality rate was 17.39%,10 patients complicated with multiple organ dysfunction syndrome,the morbidity was 43.48%.1.The multivariate regression analysis showed that SOFA score(OR= 1.231,95%CI 1.010-1.500,P=0.040)and prealbumin(OR＝0.990,95%CI 0.982-0.998,P=0.018)were the risk factors of hypoalbuminemia in septic patients.2.The APACHE Ⅱ score,SOFA score,BUN,PCT,WBC,HGB,HCT,APTT,PLT,PA of four groups were different and there were statistical significances(P<0.05),The negative correlation was found between APACHE Ⅱ score,SOFA score,BUN,PCT,APTT and serum albumin concentration,the positive correlation was found between HGB,HCT,PA,PLT and serum albumin concentration,there were statistical significances(P<0.05).The ICU mortality,morbidity of MODS,vasopressors administration incidences of group C and group D were higher than group A and group B,there were statistical significances(P<0.05).Survival curve showed the 30d living conditions of serum albumin concentration>25g/L in septic patients were better than the serum albumin concentration<25g/L.3.The ROC curve of serum albumin concentration predicted death showed the cut-off were 25.50g/L,the sensitivity were 75.90%,the specificity were 78.90%,the area under curves(AUCS)were 0.767.The cut-off of APACHE Ⅱ score and SOFA score were 18 score and 7 score,the AUCS of APACHE Ⅱ score and SOFA score were 0.733 and 0.716,respectively,there were statistical significances(P<0.01),but the compares of AUCS had no statistical significances(P>0.05).4.The multivariate regression analysis showed APACHEⅡ score(OR=1.151,95%CI 1.008-1.313,P=0.038),Lac OR=1.349,95%CI 1.017-1.790,P=0.038),ALB<25g/L(OR＝5.605,95%Ci 1.077-20.143,P=0.041)were the risk factors of death in septic patients.The area under curve of APACHE II and Lac combined ALB<25g/L was bigger than the area under curves of APACHE II or Lac which used to predicted death of septic patients.Conclusions:1.The morbidity of hypoalbuminemia was higher in patients with sepsis,SOFA score and concentration of prealbumin were the risk factors of hypoalbuminemia in septic patients.2.The values of Serum albumin concentration predicted death was worthy,the prognosis was worse in the group of Serum albumin concentration less than 25g/L.3.The value of serum albumin concentration was same as the APACHE II score and SOFA score which could assess the severity and predicted death of septic patients.4.APACHE II score,Lac,ALB<25g/L were the risk factors of death in septic patients.The value of APACHE II score and Lac combined ALB<25g/L was more exactly which used to predicted death of septic patients.