Hypoalbuminemia: Incidence and Its Impact on Acute Respiratory Distress Syndrome and 28-day Outcome in Trauma Patients

Overview

Journal Eur J Trauma Emerg Surg

Specialties Critical Care
Emergency Medicine

Date 2023 Jul 4

PMID 37402792

Authors

Mandeep Kumar

Kajal Jain

Rajeev Chauhan

Shyam Charan Meena

Ankur Luthra

Haneesh Thakur

Ajay Singh

Revathi Nair

Rekha Gupta

Affiliations

Soon will be listed here.

Abstract

Objective: This prospective observational study explored the effect of early onset hypoalbuminemia (EOH) on the development of adult respiratory distress syndrome (ARDS) in orthopedic trauma victims.

Methods: Serum albumin levels were measured for the initial 7 days of injury for adult trauma patients (18-65 years). Patients were recruited into group A (any serum albumin value < 3.5 mg/dl) and group B (all serum albumin ≥ 3.5 mg/dl), based on serum albumin values. Patients were followed for the development of ARDS and outcome until 28 days. The primary outcome of the study was to explore the effects of EOH on ARDS.

Results: EOH (any serum albumin value < 3.5 g/dl within 7 days of injury) was present in 205/386 (53.1%) patients. The majority of 174/205 (84.9%) patients had EOH by the fourth day after the injury, with the mean time for development of EOH being 2.15 ± 1.87 days. ARDS manifested in 87/205 (42.4%) and 15/181 (8.3%) patients in group A and group B, respectively (p < 0.001). EOH had 8.2 times greater odds of ARDS (OD 8.2 95% CL 4.7-14.0, p = 0.000). The mean time for the onset of ARDS was 5.63 ± 2.62 days. No statistically significant causal relationship occurred between the onset of EOH and the development of ARDS (Pearson's correlation coefficient = 0.14, p = 0.16). At serum albumin cutoff concentrations of 3.4 gm/dl on D1 (AUC 0.68, 95% CI: 0.61-0.74, p = 0.000), ARDS may be anticipated in 62.8% of patients. The commencement of ARDS was independently correlated with EOH (p = 0.000), Respiratory rate on admission (p = 0.000), inotrope use (p = 0.000), and soft tissue injury (p = 0.000) (R = 0.466). The odds of 28-day all-cause death were 7.7 times higher in EOH (OD 7.7 95% CL 3.5-16.7, p = 0.00) and 9 times higher in ARDS (OD 9 95% CL 4.9-16.16, p = 0.00).

Conclusion: EOH is a frequent occurrence and has a strong influence development of ARDS and 28-day mortality in trauma patients.

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References

Bernard G, Artigas A, Brigham K, Carlet J, Falke K, Hudson L . The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994; 149(3 Pt 1):818-24. DOI: 10.1164/ajrccm.149.3.7509706. View

Hudson L, Milberg J, Anardi D, Maunder R . Clinical risks for development of the acute respiratory distress syndrome. Am J Respir Crit Care Med. 1995; 151(2 Pt 1):293-301. DOI: 10.1164/ajrccm.151.2.7842182. View

Garwe T, Albrecht R, Stoner J, Mitchell S, Motghare P . Hypoalbuminemia at admission is associated with increased incidence of in-hospital complications in geriatric trauma patients. Am J Surg. 2015; 212(1):109-15. PMC: 4821821. DOI: 10.1016/j.amjsurg.2015.06.013. View

Goldwasser P, Feldman J . Association of serum albumin and mortality risk. J Clin Epidemiol. 1997; 50(6):693-703. DOI: 10.1016/s0895-4356(97)00015-2. View

Gonzales J, Lucas R, Verin A . The Acute Respiratory Distress Syndrome: Mechanisms and Perspective Therapeutic Approaches. Austin J Vasc Med. 2016; 2(1). PMC: 4786180. View

McNeil J, Jackson K, Wang C, Siew E, Vincz A, Shaver C . Linear Association Between Hypoalbuminemia and Increased Risk of Acute Respiratory Distress Syndrome in Critically Ill Adults. Crit Care Explor. 2021; 3(9):e0527. PMC: 8443821. DOI: 10.1097/CCE.0000000000000527. View

Zhang Z, Lu B, Ni H, Sheng X, Jin N . Prediction of pulmonary edema by plasma protein levels in patients with sepsis. J Crit Care. 2012; 27(6):623-9. DOI: 10.1016/j.jcrc.2012.08.007. View

Simsek T, Uzelli Simsek H, Canturk N . Response to trauma and metabolic changes: posttraumatic metabolism. Ulus Cerrahi Derg. 2015; 30(3):153-9. PMC: 4379844. DOI: 10.5152/UCD.2014.2653. View

Desborough J . The stress response to trauma and surgery. Br J Anaesth. 2000; 85(1):109-17. DOI: 10.1093/bja/85.1.109. View

10.

Monk D, Plank L, Franch-Arcas G, Finn P, Streat S, Hill G . Sequential changes in the metabolic response in critically injured patients during the first 25 days after blunt trauma. Ann Surg. 1996; 223(4):395-405. PMC: 1235135. DOI: 10.1097/00000658-199604000-00008. View

11.

Dijkink S, Meier K, Krijnen P, Yeh D, Velmahos G, Arbous M . The malnutrition in polytrauma patients (MaPP) study: Research protocol. Nutr Health. 2019; 25(4):291-301. PMC: 6900577. DOI: 10.1177/0260106019868884. View

12.

Brock F, Bettinelli L, Dobner T, Stobbe J, Pomatti G, Telles C . Prevalence of hypoalbuminemia and nutritional issues in hospitalized elders. Rev Lat Am Enfermagem. 2016; 24:e2736. PMC: 4990035. DOI: 10.1590/1518-8345.0260.2736. View

13.

Thongprayoon C, Cheungpasitporn W, Mao M, Sakhuja A, Kashani K . U-shape association of serum albumin level and acute kidney injury risk in hospitalized patients. PLoS One. 2018; 13(6):e0199153. PMC: 6013099. DOI: 10.1371/journal.pone.0199153. View

14.

Fahr M, Jones G, ONeal H, Duchesne J, Tatum D . Acute Respiratory Distress Syndrome Incidence, But Not Mortality, Has Decreased Nationwide: A National Trauma Data Bank Study. Am Surg. 2017; 83(4):323-331. View

15.

Yin M, Si L, Qin W, Li C, Zhang J, Yang H . Predictive Value of Serum Albumin Level for the Prognosis of Severe Sepsis Without Exogenous Human Albumin Administration: A Prospective Cohort Study. J Intensive Care Med. 2016; 33(12):687-694. DOI: 10.1177/0885066616685300. View

16.

Mangialardi R, Martin G, Bernard G, Wheeler A, Christman B, Dupont W . Hypoproteinemia predicts acute respiratory distress syndrome development, weight gain, and death in patients with sepsis. Ibuprofen in Sepsis Study Group. Crit Care Med. 2000; 28(9):3137-45. DOI: 10.1097/00003246-200009000-00001. View

17.

Trillo-Alvarez C, Cartin-Ceba R, Kor D, Kojicic M, Kashyap R, Thakur S . Acute lung injury prediction score: derivation and validation in a population-based sample. Eur Respir J. 2010; 37(3):604-9. DOI: 10.1183/09031936.00036810. View

18.

Starling E . On the Absorption of Fluids from the Connective Tissue Spaces. J Physiol. 1896; 19(4):312-26. PMC: 1512609. DOI: 10.1113/jphysiol.1896.sp000596. View

19.

van der Heijden M, Verheij J, van Nieuw Amerongen G, Groeneveld A . Crystalloid or colloid fluid loading and pulmonary permeability, edema, and injury in septic and nonseptic critically ill patients with hypovolemia. Crit Care Med. 2009; 37(4):1275-81. DOI: 10.1097/CCM.0b013e31819cedfd. View

20.

Verheij J, van Lingen A, Raijmakers P, Rijnsburger E, Veerman D, Wisselink W . Effect of fluid loading with saline or colloids on pulmonary permeability, oedema and lung injury score after cardiac and major vascular surgery. Br J Anaesth. 2005; 96(1):21-30. DOI: 10.1093/bja/aei286. View