| Background and purpose:Acute pancreatitis(AP)is one of the clinically common digestive emergencies with sudden abdominal pain as the main symptom,and some patients will develop into severe acute pancreatitis(SAP)due to persistent organ failure(> 48h).SAP patients are critically ill with many complications and a high mortality rate,and there is currently no effective treatment.Among them,many SAP patients will have hypoalbuminemia in the early stage of the disease.As an important blood product,human serum albumin(HSA)is often used for fluid resuscitation and hypoalbuminemia in various critically ill patients.However,whether exogenous infusion of human serum albumin can improve the mortality of critically ill patients is still controversial,so it is unclear whether human serum albumin infusion can improve the prognosis of SAP.Our study aims to clarify the relationship between early hypoalbuminemia and the prognosis of SAP patients,as well as the impact of human serum albumin infusion on the efficacy of SAP patients.Methods:This was a retrospective cohort study that analyzed 1000 patients with SAP who were admitted to the First Affiliated Hospital of Nanchang University between January 2010 and December 2021 using data from a prospectively maintained database.Firstly,the association between early occurrence of hypoalbuminemia and poor clinical prognosis of SAP patients was analyzed.Next,the independent risk factors for in-hospital mortality in patients with SAP were identified by univariate and multivariate logistic regression analyses.Finally,propensity score matching(PSM)analysis was adopted to evaluate the impact of human serum albumin infusion on the prognosis of SAP patients.Results:The prevalence of hypoalbuminemia(≤30 g/L)was 56.9% within 1 week after admission,and early hypoalbuminemia was associated with an increased risk of adverse clinical outcomes for SAP patients.In the hypoalbuminemia group,the in-hospital mortality(31.6% VS 18.1 %;P<0.001),sepsis(15.1% VS 7.2%;P<0.001),infected pancreatic necrosis(17.4% VS 11.6%;P=0.011),abdominal compartment syndrome(11.1% VS 6.3%;P<0.001),persistent multiple organ failure(32.2% VS19.3%;P < 0.001),persistent renal failure(28.1% VS 16.0%;P < 0.001),persistent cardiovascular failure(18.3% VS 13.2%;P= 0.031),requiring mechanical ventilation(46.4% VS 24.6%;P < 0.001)and hemofiltration(15.3% VS 9.5%;P= 0.007)were all higher than those in the normal group.Additionally,a prolonged hospital stay(18.0(19.0)VS 13.0(11.0);P < 0.001),ICU stay(9.0(15.0)VS 4.0(10.0);P < 0.001)and increased hospitalization costs(7.6(11.5)VS 4.3(6.3);P < 0.001)were noticed in the hypoalbuminemia group compared with the normal group.Multivariate logistic regression identified that age(OR:1.02;95% CI:1.00-1.04;P=0.012),serum urea(OR:1.08;95% CI:1.04-1.12;P<0.001),serum calcium(OR:0.27;95% CI:0.14-0.50;P<0.001),lowest albumin level within 1 week after admission(OR:0.93;95%CI:0.89-0.97;P=0.002),and APACHE II score ≥15(OR:1.73;95% CI:1.19-2.51;P=0.004)were independently associated with in-hospital mortality.The PSM analysis demonstrated that mortality(OR:0.52;95% CI:0.29-0.92;P=0.023)was less common in albumin-infused than non-albumin-infused hypoalbuminemia patients.In subgroup analyses,doses>100 g within 1 week after admission for hypoalbuminemia patients with albumin infusions was associated with lower mortality than doses≤100 g(OR:0.51;95% CI:0.28-0.90;P=0.020).Conclusions:SAP patients with hypoalbuminemia have a poor prognosis and a high mortality rate.Early and sufficient infusion of human serum albumin can reduce the mortality rate of SAP patients with hypoalbuminemia. |
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