Prognostic Importance of Hypoalbuminemia in Patients with Severe Sepsis and Septic Shock

ABSTRACT

PURPOSE: This study investigated the association between hypoalbuminemia and 28-day mortality in patients with severe sepsis and septic shock. METHODS: A prospective observational study, including consecutive patients with severe sepsis and septic shock, was performed from July 2008 to June 2011. Patient demographic data, comorbidities, blood test results (including albumin concentration), and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were compared between 28-day survivors and non-survivors. Patients were divided into normal albumin (> or =3.3 mg/dl) and hypoalbuminemia (<3.3 mg/dl) groups. The Cox proportional hazards regression analysis was conducted to identify the predictors of 28-day mortality. Analysis of the area under the receiver operating characteristic curve was performed to compare the prognostic performance of albumin concentrations versus APACHE II scores. RESULTS: During the study period, a total of 493 patients were included and 140(28.4%) died. The albumin concentrations of non-survivors were significantly lower than those of survivors (3.3+/-0.6 mg/dl vs. 2.8+/-0.6 mg/dl, respectively) and the hypoalbuminemia group had a higher mortality rate than the normal albumin group (41.2% vs. 10.3%, respectively, p<0.01). In Cox analysis, hypoalbuminemia was associated with a 3.8-fold increased risk of death during the 28-day follow-up period (hazard ratio, 3.83; 95% CI, 2.22-6.59). The AUC of albumin concentration was 0.73(95% CI, 0.69-0.78), which was comparable with that of APACHE II score (0.77; 95% CI, 0.73-0.81). CONCLUSION: Hypoalbuminemia is an independent predictor of 28-day mortality in patients with severe sepsis and septic shock.