Clinical significance of dynamic hypoalbuminemia monitoring in children with severe sepsis

Objective To study serum albumin levels in children with severe sepsis and to correlate serum albumin levels with patient outcome and to identify the causes inducing hypoalbuminemia and its effective countermeasures.Methods Seventy-five children admitted to PICU of Provincial Hospital Affiliated to Shandong University for severe sepsis were included in the study from Aug 2010 to Sep 2011.According to their serum albumin levels within 24 hours and on the third and the seventh day of admission to PICU,75 children were divided into hypoalbuminemia group and normal serum albumin group.Then hypoalbuminemia group was divided into instant hypoalbuminemia group and continuous hypoalbuminemia group according to the duration of hypoalbuminemia.The correlation between the occurring and duration of hypoalbuminemia with patients' prognosis,the etiopathogenisis of hypoalbuminemia and its effective countermeasures were analyzed.Results (1) Sixty-three cases (84.0％) proceeded hypoalbuminemia and their mortality was 33.3％ (21/63),while 12 cases (16.0％) showed normal serum albumin level and their mortality was 0.(2) In 63 patients with hypoalbuminemia,26 cases showed continuous hypoalbuminemia and their mortality was 46.0％,while 37 cases proceeded instant hypoalbuminemia and their mortality was 15.4％.There was significant difference (x2 =5.116,P ＜ 0.05) between their mortality.(3) In the 63 cases with hypoalbuminemia,32 cases presented with hepatic injury and their mortality was 37.5％,13 cases proceeded capillary leakage and their mortality was 23.1％,and 18 cases displayed hepatic injury complicated with capillary leakage and their mortality was 33.3％.There was significant difference (x2 =7.812,P ＜ 0.05) between the mortality with different causes.Conclusion Hypoalbuminemia influenced the prognosis of children with severe sepsis,the longer duration correlated with the worse prognosis.Hepatic injury and capillary leakage were two main causes inducing hypoalbuminemia.Active treatment of hypoproteinemia aimed directly at different causes could improve their prognosis significantly. Key words: Severe sepsis ;  Hypoalbuminemia;  Capillary leakage;  Children