Title : Albumin in intensive care
Abstract:
Introduction: Hypoalbuminemia is a common biological disorder in intensive care. Its causes are multiple: malnutrition, decreased hepatic synthesis or overt liver failure, hemodilution, hemorrhage, capillary leak, digestive or cutaneous exudative losses, as well as functional hypoalbuminemia due to structural modifications or cleavage into inactive forms.
It represents an unfavorable prognostic factor regardless of the etiology and, in high-risk situations such as sepsis, promotes the development of ARDS.
Materials and Methods: We conducted a retrospective descriptive and analytical study over a two-year period (January 1, 2021 – December 31, 2022), including 349 patients with hypoalbuminemia (serum albumin < 35 g/L), admitted to the Surgical Emergency Intensive Care Unit P33 of Ibn Rochd Hospital.
Collected data included epidemiological, clinical, biological, therapeutic, and outcome variables. Patients were divided into two groups:
- Group S: severe hypoalbuminemia (≤ 25 g/L)
- Group M: moderate hypoalbuminemia (25–35 g/L)
Results:
- The incidence of hypoalbuminemia was 35%.
- The mean age of patients was 48.2 years (range: 15–90 years).
- There was a male predominance: 70.8% male (247 cases) versus 28% female (102 cases), with a male-to-female ratio of 2.42.
Impact of albumin infusion: No significant benefit was observed between patients who received albumin infusion and those who did not (p > 0.05)
Factors associated with severe hypoalbuminemia
- Admission for postoperative care, traumatic brain injury, or altered consciousness (p < 0.001)
- Albumin infusion (p = 0.002)
- Parenteral nutrition (p = 0.037)
- Antibiotic therapy (p < 0.001)
- Elevated CRP level (p = 0.0047)
Factors associated with mortality
- Admission for postoperative care (p = 0.043)
- Tumor pathology (p = 0.049)
- Use of vasopressor drugs (p < 0.001)
- Development of pressure ulcers during hospitalization (p = 0.019)
Overall mortality was 43.8%, occurring more frequently in Group S (50.3%) than in Group M (38.2%).
This difference was statistically significant (p = 0.024; OR = 1.632; 95% CI: 1.210–2.203).
Conclusion: Our study demonstrates that hypoalbuminemia is an independent predictive factor of mortality in intensive care. Its severity directly impacts patient outcomes, highlighting the importance of considering it in the overall management of critically ill patients.
