PURPOSE: Sepsis is a leading cause of death in Critical Care Units. It is often difficult to differentiate septic shock from other types of shock on admission. The aim of this study is to explore whether low serum albumin on admission helps in differentiating septic shock from other types of shock.
METHODS: Retrospective study where data was extracted using International Classification of diseases -9(ICD-9) codes; 785.52 for Septic Shock, 785.51 for Cardiogenic Shock, 785.59 Shock not elsewhere specified (NES) without mention of trauma (w/t). All these patients were admitted to intensive care unit from emergency room and had documented serum albumin on admission and all had prior serum albumin more than equal to 3gm/dl.
RESULTS: Total number of patients with a diagnosis of shock was 603 and 99 patients were included. Patients with septic shock were 49, cardiogenic shock were 26 and Shock NES w/t were 24. The median value of serum albumin on admission for septic shock, shock w/t NES and cardiogenic shock was 2.7, 2.8 and 3.5 gm/dl respectively. Median serum albumin on admission was lower for septic shock when compared to cardiogenic shock. (P<0.001) There was also statistical significant difference between the admission albumin between cardiogenic and shock w/t NES (P<0.001).There was no statistical significant difference between the mean serum albumin on admission between septic shock and shock w/t NES (P>0.05). Serum albumin of 3gm/dl or less on admission has a sensitivity of 68% (95% CI 0.51-0.78) and specificity of 92% (95% CI 0.75-0.97) to differentiate cardiogenic shock from all other types of shock.
CONCLUSIONS: Low serum albumin on admission serves as a diagnostic marker to differentiate septic shock from cardiogenic shock but not from shock NES w/t. High serum albumin of more than 3 gm/dl on admission can be used as a marker to differentiate cardiogenic shock from any other types of shock.
CLINICAL IMPLICATIONS: Early identification of shock using serum albumin may improve outcomes in shock.
DISCLOSURE: The following authors have nothing to disclose: Jaya Bhattarai, Bipin Barun, James Walsh
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