The prognostic value of serum albumin level in early stage of severe sepsis

Objective To investigate the predictive value of serum albumin level in patients with severe sepsis. Methods One hundred and twenty cases of patients with severe sepsis admitted to Qilu Hospital, Shandong University from April 2014 to October 2014 were prospectively enrolled. The serum albumin levels were measured and the laboratory and clinical data were collected at the onset of severe sepsis. Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score and Sequential Organ Failure Assessment (SOFA) score were calculated. Patients were grouped according to the prognosis by day 28 or stratified by albumin level. Prognostic factors were analyzed by multivariable Logistic regression. Results A total of 120 patients were enrolled with mean age of (57.6±18.3) years, among which 75 were male. The mean duration of hospitalization was (20.1±17.8) days. The 28-day mortality was 25.8% (31/120). The most common infection sources were respiratory tract (56.7%), abdominal/pelvis (19.2%) and bloodstream (9.2%). Serum albumin level in survival group was significantly higher than that in death group ([32.1±6.4] g/L vs [27.5±5.5] g/L, t=3.562, P=0.001). Compared with survival group, the patients in death group had higher APACHE Ⅱ and SOFA scores (22.0±9.1 vs 13.4±7.2; 7.1±3.7 vs 4.3±3.5; t= —5.372 and —3.690, both P<0.05). Along with the decrease of serum albumin level, the incidence of bloodstream infection, solid tumor, septic shock, acute kidney injury and liver injury significantly increased. Patients with lower albumin level had significantly higher SOFA scores and 28-day mortality (all P<0.05). Multivariable regression analysis showed that albumin level lower than 28 g/L and higher APACHE Ⅱ score were independent risk factors for mortality (OR=4.156, 95%CI: 1.198—14.415; OR=1.121, 95%CI: 1.039—1.210; both P<0.05). Conclusions A significantly lowered serum albumin level would increase the risk of mortality in patients with severe sepsis. The combination of albumin level and APAHCE Ⅱ score might be beneficial to evaluate the prognosis. Key words: Serum albumin; Severe sepsis; Prognosis; Risk factors