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Serum albumin and clinical outcome in pediatric cardiac surgery
Heitor Pons Leite1, Mauro Fisberg, Werther Brunow de Carvalho
1Pediatric Intensive Care Unit and Discipline of Nutrition and Metabolism, Department of Pediatrics, Federal University of São Paulo, Escola Paulista de Medicina, São Paulo, Brazil. heitorpl@terra.com.br
Insights
Low serum albumin (hypoalbuminemia) is common in high-risk children undergoing heart surgery. Levels below 3 g/dL predict worse outcomes, including infection and longer hospital stays.
Area of Science:
- Cardiology
- Pediatric Surgery
- Biochemistry
Background:
- Congenital heart defects often require complex surgical correction.
- Children with severe heart disease face significant metabolic stress during cardiac surgery.
- Serum albumin levels may reflect nutritional status and stress response.
Purpose of the Study:
- To assess serum albumin behavior during metabolic stress from cardiac surgery.
- To determine if serum albumin predicts clinical outcomes in high-risk pediatric surgical patients.
- To investigate hypoalbuminemia in children undergoing congenital heart defect repair.
Main Methods:
- Measured serum albumin in 30 high-risk pediatric cardiac surgery patients pre-op, post-op day 2, and ICU discharge.
- Compared patient albumin levels to 20 healthy controls.
- Analyzed correlations between albumin levels and clinical outcomes.
Main Results:
- Preoperative albumin was lower in patients (3.4 g/dL) than controls (4.0 g/dL).
- Albumin levels decreased post-surgery (3.1-3.2 g/dL).
- Preoperative levels <3.0 g/dL correlated with higher infection rates (P=0.0026) and mortality (P=0.0138).
- Postoperative levels <3.0 g/dL led to longer hospital stays (14.5 vs. 10 days).
Conclusions:
- Hypoalbuminemia is prevalent in high-risk pediatric cardiac surgery patients.
- Serum albumin <3.0 g/dL is associated with adverse clinical outcomes.
- Albumin levels may serve as a prognostic marker in this population.
Objective:
We evaluated the behavior of serum albumin concentrations in response to metabolic stress that is associated with cardiac surgery and the role of this protein as a predictor of clinical outcome in children at high surgical risk who undergo operative correction of congenital heart defects.
Methods:
Serum albumin concentrations were measured in 30 children who had heart disease and were at high surgical risk. Analyses were performed before surgery, on the second postoperative day, and on discharge from the intensive care unit. Preoperative serum concentrations of albumin were compared with those of a control group that consisted of 20 healthy and well-nourished children.
Results:
Preoperative albumin concentrations of patients were lower than those of the control group (3.4+/-0.25 g/dL versus 4.0+/-0.18 g/dL, P<0.05). Serum levels decreased on the second postoperative day and at discharge from the intensive care unit (3.1+/-0.65 g/dL and 3.2+/-0.44 g/dL, P<0.05) compared with preoperative concentrations. Preoperative concentrations lower than 3.0 g/dL were associated with increased postsurgical infection (P=0.0026) and with increased mortality (P=0.0138). Patients whose postoperative levels were lower than 3.0 g/dL had longer hospital stays compared with those whose concentrations were higher than 3.0 g/dL (14.5+/-1.3 d versus 10+/-2.2 d, P<0.05).
Conclusion:
The results suggest that hypoalbuminemia is common among children who have heart disease and are at high surgical risk, and serum albumin concentrations lower than 3 g/dL may be related to outcome in the period after cardiac surgery.
