Abstract

Introduction: Sepsis has very high morbidity and mortality, which leads to a major healthcare burden in the world. Though there is vast advancement in the therapeutic options, the mortality rate remains high due to the delay in the diagnosis because of the lack of availability of reliable diagnostic methods. In sepsis, there is potent activation of inflammatory cascade leading to endothelial dysfunction and an increase in systemic capillary permeability. In kidney, there is a loss of barrier integrity and capillary leak in the glomerulus resulting in increased excretion of albumin in the urine. The main objective of the study is to determine the role of serial monitoring of serum albumin levels as a predictor of mortality and morbidity in sepsis patients admitted in ICU and to find out whether there is a quantitative correlation between serum albumin levels and mortality risk associated.

Methodology: This descriptive study was conducted on 70 sepsis patients admitted in the medical intensive care unit and surgical intensive care unit in Rajah Muthiah Medical College & Hospital, Annamalainagar, during the study period of November 2018 to August 2020. All the selected patients were completely evaluated and their serum albumin was measured on day 1 of sepsis diagnosis followed by day 3 and day 5. Patients were followed up during the course of hospital stay and the outcome of the patient (i.e. Death/Survival) was recorded. Data was entered in MS Excel sheet and analysed  using SPSS (statistical product and service solutions) software version 18. Institutional Ethical Committee approval was obtained before the start of the study.

Results:The 70 patients selected for the study were divided into Survivor and non-survivor groups. The mean level of serum albumin at day 1 was 3.72 g/dl (+ 0.278) in survivor group and in non-survivors group, it was 3.11 g/dl (+ 0.247). The mean level of serum albumin at day 3 was 3.17 g/dl (+ 0.248) in survivor group and in non-survivors group, it was 2.65 g/dl (+ 0.172). The mean level of serum albumin at day 5 was 2.72 g/dl (+ 0.25) in survivor group and in non-survivors group, it was 2.32 g/dl (+ 0.144). The    difference in mean serum albumin in day1, 3 and 5 was statistically significant with p value <0.001 by unpaired t test. The decline in mean serum albumin level in survivors from day 1to day 5 was 3.72 g/dl to 2.72 g/dl. In non-survivors it is 3.11 g/dl to 2.32 g/dl.

Conclusion: In this study a serum albumin level below 3.5 gm/dl in all three days correlates directly with poor prognosis in sepsis patient. Both survivor and non-survivor groups had gradual fall in serum albumin level from day 1, but the fall below 3.0 gm/dl was associated with higher mortality. It suggests that the rapidity with which serum albumin falls below the normal level has an effect on the prognosis of the sepsis patient in terms of mortality. Serum albumin measurement is cheaper and it’s serial measurement may help in the clinical assessment of sepsis patient’s, who is at the risk of poor prognosis even in resource poor areas.

Keywords: Serum albumin, Sepsis, Intensive care unit.