title: Serum Albumin Is an Independent Predictor of Clinical Outcomes in Critically Ill Children.
abstract: OBJECTIVE
  Serum albumin is a strong biomarker of disease severity and prognosis in adult patients. In contrast, its value as predictor of outcome in critically ill children has not been established. We aimed to determine whether admission hypoalbuminemia is associated with outcome in a general pediatric population of critically ill patients, taking into account the inflammatory response, disease severity, and nutritional status of the patient.
  
  
  METHODS
  Analysis of prospectively collected database.
  
  
  METHODS
  PICU of a teaching hospital.
  
  
  METHODS
  Two hundred seventy-one patients consecutively admitted. Neonates, patients with chronic liver or kidney disease, inborn errors of metabolism, those who received prior administration of albumin solution, and readmissions were excluded.
  
  
  RESULTS
  Outcome variables were 60-day mortality, probability of ICU discharge at 60 days, and ventilator-free days. Potential exposure variables for the outcome were sex, age, nutritional status, albumin, C-reactive protein and serum lactate at admission, and Pediatric Index of Mortality 2 score. Admission hypoalbuminemia was present in 64.2% of patients. After adjustment for confounding factors, only serum lactate, Pediatric Index of Mortality 2 score, and serum albumin were associated with higher mortality: the increase of 1.0 g/dL in serum albumin at admission resulted in a 73% reduction in the hazard of death (hazard ratio, 0.27; 95% CI, 0.14-0.51; p < 0.001). The increase of 1 g/dL in serum albumin was also independently associated with a 33% rise in the probability of ICU discharge (subhazard ratio, 1.33; 95% CI, 1.07-1.64; p = 0.008) and increased ventilator-free-days (odds ratio, 1.86; 95% CI, 0.56-3.16; p = 0.005).
  
  
  CONCLUSIONS
  Hypoalbuminemia at admission to a PICU is associated with higher 60-day mortality, longer duration of mechanical ventilation, and lower probability of ICU discharge. These associations are independent of the magnitude of inflammatory response, clinical severity, and nutritional status.
authors.affiliation: 1Discipline of Nutrition and Metabolism, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil. 2Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil. 3Pediatric Intensive Care Unit, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil. 4Pediatric Nephrology Section, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Heitor Pons
authors.initials: HP
authors.lastname: Leite
authors.forename: Alessandra Vaso
authors.initials: AV
authors.lastname: Rodrigues da Silva
authors.forename: Simone Brasil
authors.initials: SB
authors.lastname: de Oliveira Iglesias
authors.forename: Paulo Cesar
authors.initials: PC
authors.lastname: Koch Nogueira
mesh_terms: D002648:Child; D046688:Child Mortality; D002675:Child, Preschool; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D034141:Hypoalbuminemia / Q000150:complications* / Q000401:mortality; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D063868:Patient Outcome Assessment; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism*
chemical_list: D012709:Serum Albumin