PURPOSE: Serum albumin (SA) is a useful marker of nutritional status. The current work was conducted to study the SA levels at presentation and early hospital stay of critically ill patients requiring mechanical ventilation and to correlate them with outcome of these patients.
METHODS: Fifty two critically ill patients (Mean age 45±19 yrs, M:F 37:15) who required at least 5 days of mechanical ventilation were included over a 6 month period. All patients surviving for less than 3 days were excluded. All management decisions including those related to nutritional support were the prerogative of the ICU team. SA estimation was done on day 1, 3,5,10 and 15. Hospital mortality was the primary outcome variable.
RESULTS: Study group consisted of patients with sepsis (n=12, 24%), chronic obstructive pulmonary disease (n=11, 22%), and severe pneumonia (n=10, 20%) among others. Hospital mortality was 40% (n=21). Mean SA levels showed consistent fall during hospital stay (mean SA on day 1, 3, 5, 10 & 15 were 3.2±0.7 gm%, 2.9±0.6 gm%, 2.9±0.6 gm%, 2.8±0.6 gm%, 2.7±0.65 gm% respectively). There was no statistically significant difference between day 1 mean SA levels for survivors and non-survivors. On the other hand, the difference between the two groups became statistically significant day 3 onwards and remained so subsequently (Figure). On comparing the outcome between the patients divided into two groups based on cutoff of SA levels of 3 gm%, it was found that outcome was not different for day 1 & 3. However, mortality for patients with SA < 3 gm% was significantly higher than those with SA > 3 gm% at day 5 (52.6% vs. 9.5%, OR, 95% CI: 10.5, 1.9–58.5, P=0.003) and remained so later.
CONCLUSION: In critically ill patients, nutritional status as estimated by SA levels, tends to deteriorate during the hospital stay. In comparison to SA levels at presentation, those done later are better predictors of mortality.
CLINICAL IMPLICATIONS: Serial estimations of SA levels may provide useful prognostic information in critically ill patients.
DISCLOSURE: Amit Banga, None.