To Study Role of Serial Serum Albumin Estimation as Prognostic Marker in Critically Ill Patients.

Unlabelled: Albumin is the most abundant plasma protein in humans. It works to maintain the colloid oncotic pressures, acts as a carrier protein, and is involved in metabolism, antioxidant, and various other functions. Patients who are admitted to the Intensive Care Unit (I.C.U.) are at an increased risk of mortality due to the severity of their illness. It is thus, important to identify patients at the time of admission who are likely to have a poor outcome so that such patients can be managed aggressively. Serum Albumin appears to be one such prognostic indicator. Its utility as a prognostic indicator has been studied in various contexts including critically ill patients. A low serum albumin concentration correlates with the increase in length of stay in ICU, increasing the risk of death and frequent readmission. The daily trend of serum albumin can be a useful tool in predicting the weaning capability of patients needing mechanical ventilation.

Material: The study was conducted on 100 adult patients of both sexes who are critically ill admitted in the emergency wards and ICU unit in the GMC Kota were included in the study Inclusion Criteria: Critical ill patients will be defined as those who either have multi-organ dysfunction and/or sepsis, need ventilatory support, and required intensive care.

Exclusion Criteria: Chronic liver failure, Nephrotic syndrome/chronic kidney disease, Protein-losing enteropathy, Chronic malnutrition.

Observation: It was observed during the study that the mean age of the study population was 54.5years. The mean age in survivors was 49.6 years. The mean age in non-survivors was 62.3 years. There was a significant difference (p = 0.0024) between the two groups indicating a higher age at admission for non-survivors. The total decline in serum albumin in the survivors from admission to day10 is 0.75 g/dl. In nonsurvivors, it is 1.07 g/dl over a period of 10 days. The fall in nonsurvivors is steeper than survivors. It suggests that the rapidity with which serum albumin level falls has an effect on the prognosis of the patient in terms of mortality. A steep decline in serum albumin indicates a poor prognosis.

Conclusion: The result shows that serial measurement of serum albumin can accurately predict the outcome. Survivors had significantly higher serum albumin levels all day compared to non-survivors. Serum albumin is routinely measured in all patients and it is a cheap and easily available test facility in all laboratories.