Significance Of Serum Albumin Decrease Rate In Assessing The Prognosis Of Patients With Severe Sepsis And Septic Shock Su Pengtao

Objective To investigate the relationship between serum albumin decrease rate and the severity of severe sepsis and septic shock, and to investigate significance of serun albumin decrease rate in assessing the prognosis of patients with severe sepsis and septic shock. Methods Thirty six patients with severe sepsis and septic shock, including 23 patients with severe sepsis and 13 patients with septic shock, in the emergency ICU of the First Affiliated Hospital of Dalian Medical University from April 2014 to January 2015 were retrospectively analyzed. On the first and third days after admission, serum albumin of patients was detected and serum albumin decreased rate was calculated; PCT was detected; arterial blood gas was measured and oxygenation index was calculated; and meantime APACHE II score was assessed. The patients were divided into survival group and death group based on survival or death on the twenty-eighth day, and the differences in serum albumin on day 1, serum albumin decrease rate and APACHE Ⅱ score between the survival group and death group were compared by using two independent samples t-test. The relationship between serum albumin on day 1, serum albumin decrease rate and APACHE Ⅱ score, oxygenation index, PCT using Spearman correlation analysis;receiver operating characteristic(ROC) curve that serum albumin on day 1, serum albumin decrease rate and APACHE Ⅱscore predict mortality was established; the optimal cut-off value that serum albumin on day 1, serum albumin decrease rate and APACHE Ⅱ score predict mortality was determined by means of Youden index. Results APACHE II score of 36 patients was 26.3 ± 8.2; hypoproteinemia occurred in 75%(25/36); the average albumin on day 1 was 30.7 ± 5.5 g/L; the average albumin decreased rate was 0.15 ± 0.15; APACHE II in the survival group was significantly lower than that in death group(P=0.001); the average albumin on day 1 in the survival group was significantly higher than that in the death group(P<0.05); the average albumin decreased rate in the survival group was significantly lower than that in the death group(P=0.001); the albumin on day 1 was negatively related to APACHE II(r=-0.524, P<0.01), and the albumin decreased rate was positively related to APACHE II(r=0.420, P<0.05). The albumin on day 1 was positively related to oxygenation index(r=0.528, P<0.01), the albumin decrease rate was negatively correlated to oxygenation index(r=-0.535, P<0.01); The albumin on day 1 was negatively related to PCT(r=-0.400,P<0.05), the albumin decrease rate was positively correlated to PCT(r=0.442,P<0.01); ROC curve area that APACHE II score predicts mortality was 0.922(95% confidence interval: 0.835, 0.974, P<0.01); the maximum Youden index was 0.714 and the best truncation threshold was 26 with the sensitivity of 0.867 and the specificity of 0.762. The ROC curve area that albumin on day 1 predicts mortality was 0.749(95% confidence interval: 0.590, 0.908, P<0.05); the maximum Youden index was 0.457 and the optimal cut-off threshold was 31.6 with the sensitivity of 0.93 and the specificity of 0.524. The ROC curve area that the albumin decreased rate predicts mortality was 0.832(95% confidence interval: 0.658, 0.922, P<0.01); the maximum Youden index was 0.800 and the optimal cut-off threshold was 0.221 with the sensitivity of 0.800 and the specificity of 0.950. Conclusion Increased serum albumin decrease rate is closely related to the severity of severe sepsis and septic shock, what has an important reference value for judging the prognosis; serum albumin decrease rate may predict the prognosis of patients with severe sepsis and septic shock well.