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Serum Albumin as a Biomarker of Poor Prognosis in the Pediatric Patients in Intensive Care Unit
Young Suh Kim1, In Suk Sol1,2, Min Jung Kim1,2
1Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
Insights
Low serum albumin levels in pediatric intensive care unit (ICU) patients indicate a higher risk of mortality. Hypoalbuminemia serves as a significant biomarker for poor prognosis in critically ill children, comparable to established scoring systems.
Area of Science:
- Pediatric Critical Care Medicine
- Biomarkers in Pediatrics
- Clinical Chemistry
Background:
- Serum albumin's prognostic value for mortality is established in adults but not in pediatric intensive care unit (ICU) patients.
- Investigating albumin as a prognostic biomarker in critically ill children is crucial.
Purpose of the Study:
- To determine if serum albumin level is a biomarker of poor prognosis in pediatric ICU patients.
- To compare albumin's predictive value against established mortality indices in children.
Main Methods:
- Retrospective analysis of 431 pediatric ICU patients' medical records from 2012-2015.
- Exclusion criteria included early mortality, hepatic/renal failure, and prior albumin replacement.
Main Results:
- Hypoalbuminemia was associated with significantly higher 28-day mortality (24.60% vs. 9.28%).
- Children with low albumin had elevated Pediatric Index of Mortality (PIM) 3 and Pediatric Risk of Mortality (PRISM) III scores, higher septic shock incidence, and increased inflammatory markers (CRP, delta neutrophil index).
- Serum albumin negatively correlated with PIM 3 and PRISM III scores.
Conclusions:
- Hypoalbuminemia is a significant biomarker for poor prognosis in pediatric ICU patients.
- Low serum albumin levels can predict mortality risk in critically ill children.
Background:
Serum albumin as an indicator of the disease severity and mortality is suggested in adult patients, but its role in pediatric patients has not been established. The objectives of this study are to investigate the albumin level as a biomarker of poor prognosis and to compare it with other mortality predictive indices in children in intensive care unit (ICU).
Methods:
Medical records of 431 children admitted to the ICU at Severance Hospital from January 1, 2012 to December 31, 2015 were retrospectively analyzed. Children who expired within 24 hours after ICU admission, children with hepatic or renal failure, and those who received albumin replacement before ICU admission were excluded.
Results:
The children with hypoalbuminemia had higher 28-day mortality rate (24.60% vs. 9.28%, P < 0.001), Pediatric Index of Mortality (PIM) 3 score (9.23 vs. 8.36, P < 0.001), Pediatric Risk of Mortality (PRISM) III score (7.0 vs. 5.0, P < 0.001), incidence of septic shock (12% vs. 3%, P < 0.001), C-reactive protein (33.0 mg/L vs. 5.8 mg/L, P < 0.001), delta neutrophil index (2.0% vs. 0.6%, P < 0.001), lactate level (1.6 mmol/L vs. 1.2 mmol/L, P < 0.001) and lower platelet level (206,000/μl vs. 341,000/μl, P < 0.001) compared to the children with normal albumin level. PIM 3 (r = 0.219, P < 0.001) and PRISM III (r = 0.375, P < 0.001) were negatively correlated with serum albumin level, respectively.
Conclusions:
Our results highlight that hypoalbuminemia can be a biomarker of poor prognosis including mortality in the children in ICU.
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