Introduction: Hypoalbuminemia is a frequent and early biochemical derangement in critically ill-patients and is considered as a marker of disease severity and predictor of increased morbidity and mortality. The objective of the study is to evaluate prevalence of hypoalbuminemia and its association with disease severity and clinical outcome of illness in critically ill children.

Methods: A prospective observational study conducted at the PICU of Tertiary care Hospital. Children aged 1year to 12 years admitted to PICU were included. Serum albumin levels were estimated at the time of admission to PICU. 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. Pediatric risk of mortality III (PRISM-III) scoring system was used to assess the severity of illness at admission.

Results: The prevalence of hypoalbuminemia at admission was 38%. Mean serum albumin level in this study was 2.54 ± 0.38 g/dl. A lower s.albumin concentration correlated well with higher rates of complications such as ventilator dependency and development of new infections leading to longer length of PICU stay and higher mortality (31.5%). The mean length of PICU stay (8.6 ± 5.1; p<0.001) was statistically longer than those with normal albumin. A Strong negative correlation(r= -0.867) found between s.albumin level and the mortality rate.

Conclusion: Hypoalbuminemia at admission can be helpful for risk assessment and can be used as an outcome predictor in critically ill children.

Keywords: Critical ill children, Hypoalbuminemia, Mortality, PICU, PRISM III, S.Albumin

1. Straney L, Clements A, Parslow RC, Pearson G, Shann F, Alexander J, Slater A, ANZICS Paediatric Study Group and the Paediatric Intensive Care Audit Network. Paediatric index of mortality 3: an updated model for predicting mortality in pediatric intensive care. Pediatric critical care medicine. 2013 Sep 1;14(7):673-81.
2. Sitar ME, Aydin S, Cakatay U. Human serum albumin and its relation with oxidative stress. Clin Lab. 2013 Jan 1;59(9-10):945-52.
3. Vincent JL, Dubois MJ, Navickis RJ, Wilkes MM. Hypoalbuminemia in acute illness: is there a rationale for intervention?: a meta-analysis of cohort studies and controlled trials. Annals of surgery. 2003 Mar;237 (3):319.
4. Nicholson JP, Wolmarans MR, Park GR. The role of albumin in critical illness. British journal of anaesthesia. 2000 Oct 1;85(4):599-610.
5. Peters Jr T. All about albumin: biochemistry, genetics, and medical applications. Academic press; 1995 Dec 21
6. Goldwasser P, Feldman J. Association of serum albumin and mortality risk. Journal of clinical epidemiology. 1997 Jun 1;50(6):693-703.
7. Zimmerman JE, Kramer AA, McNair DS, Malila FM. Acute Physiology and Chronic Health Evaluation (APACHE) IV: hospital mortality assessment for today’s critically ill patients. Critical care medicine. 2006 May 1;34(5):1297-310.
8. Rady MY, Ryan T. Perioperative predictors of extubation failure and the effect on clinical outcome after cardiac surgery. Critical care medicine. 1999 Feb 1;27(2):340-7.
9. Horowitz IN, Tai K. Hypoalbuminemia in critically ill children. Archives of pediatrics & adolescent medicine. 2007 Nov 1;161(11):1048-52.
10. Durward A, Mayer A, Skellett S, Taylor D, Hanna S, Tibby SM, Murdoch IA. Hypoalbuminaemia in critically ill children: incidence, prognosis, and influence on the anion gap. Archives of Disease in childhood. 2003 May 1;88(5):419-22.
11. Nicholson JP, Wolmarans MR, Park GR. The role of albumin in critical illness. British journal of anaesthesia. 2000 Oct 1;85(4):599-610.
12. Fleck A, Hawker F, Wallace PI, Raines G, Trotter J, Ledingham IM, Calman KC. Increased vascular permeability: a major cause of hypoalbuminaemia in disease and injury. The Lancet. 1985 Apr 6;325(8432):781-4.
13. Tiwari LK, Singhi S, Jayashree M, Baranwal AK, Bansal A. Hypoalbuminemia in critically sick children. Indian J Crit Care Medi. 2014 Sep;18(9):565.
14. Golhar ST, Agrawal H, Chauhan UM,  Madhura A. Hypoalbuminemia in critically sick children. Int J Contemp Pediatr 2019;6:922-6.
15. Kittisakmontri K, Reungrongrat S, Lao-araya M. Hypoalbuminemia at admission predicts the poor outcomes in critically ill children. Anaesthesiol Intensive Ther. 2016;48(3):158-61.
16. Carter DC, Ho JX. Structure of serum albumin. Adv Protein Chem. 1994;45:153-203
17. Kumar S, Aroor S, Kini PG, Mundkur S, Moideen A. Hypoalbuminemia as a marker of adverse outcome in children admitted to pediatric intensive care unit. Indian J Child Health. 2018; 5(1):6-10.
18. Murray MJ, Marsh HM, Wochos DN, Moxness KE, Offord KP, Callaway CW. Nutritional assessment of intensive-care unit patients. Mayo Clin Proc. 1988;63:1106–15. [PubMed] [Google Scholar]
19. Foley EF, Borlase BC, Dzik WH, Bistrian BR, Benotti PN. Albumin supplementation in the critically ill. A prospective, randomized trial. Arch Surg 1990;125:739-42.
20. Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004;350:2247-56.

Indira Teronpi

Department of Pediatrics, Silchar Medical College and Hospital, Silchar, Assam India