Kendall Heather, Abreu Eduardo, Cheng An-Lin
1 University of Missouri-Kansas City School of Nursing and Health Studies, Kansas City, MO, USA.
2 Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
Biol Res Nurs. 2019 May;21(3):237-244. doi: 10.1177/1099800419827600. Epub 2019 Feb 5.
Patients admitted to the hospital with sepsis are 8 times more likely to die than patients with other diagnoses. There is no diagnostic test that clearly identifies the presence of the dysregulated host response that is central to sepsis. Researchers have identified serum albumin as a possible predictor of mortality in a number of critically ill patient populations. However, these studies primarily focus on the levels on admission, neglecting the clinically significant decrease that occurs subsequently. The purpose of this study was to examine the relationship between the trend of serum albumin over time and mortality in adults admitted to the intensive care unit (ICU) with sepsis.
This retrospective, correlational study used existing medical record data. All patients admitted to the ICU at a Midwestern regional medical center with a primary sepsis diagnosis were included in the initial sample. Logistic regression analysis was used to assess the ability of serum albumin to predict mortality.
Serum albumin trend, admission serum albumin level, and lowest serum albumin level were significant unique predictors of mortality. The probability of survival decreases by 70.6% when there is a strong negative trend in serum albumin level, by 63.4% when admission serum albumin is ≤2.45 g/dl, and by 76.4% when the lowest serum albumin is ≤1.45 g/dl.
Clinicians are encouraged to measure serum albumin levels in patients with sepsis. Low serum albumin levels and a strong negative trend in serial measurements should instigate aggressive monitoring and treatment in this population.
因脓毒症入院的患者死亡可能性是患有其他诊断疾病患者的8倍。目前尚无诊断测试能明确识别出脓毒症核心的宿主反应失调情况。研究人员已确定血清白蛋白可能是一些重症患者群体死亡率的预测指标。然而，这些研究主要关注入院时的水平，而忽略了随后出现的具有临床意义的下降情况。本研究的目的是探讨入住重症监护病房（ICU）的脓毒症成年患者血清白蛋白随时间变化的趋势与死亡率之间的关系。
这项回顾性相关性研究使用了现有的病历数据。最初的样本包括在中西部地区医疗中心因原发性脓毒症诊断入住ICU的所有患者。采用逻辑回归分析来评估血清白蛋白预测死亡率的能力。
血清白蛋白趋势、入院时血清白蛋白水平和最低血清白蛋白水平是死亡率的显著独立预测指标。当血清白蛋白水平呈强烈负趋势时，存活概率降低70.6%；当入院时血清白蛋白≤2.45 g/dl时，存活概率降低63.4%；当最低血清白蛋白≤1.45 g/dl时，存活概率降低76.4%。
鼓励临床医生测量脓毒症患者的血清白蛋白水平。低血清白蛋白水平以及连续测量中出现的强烈负趋势应促使对该人群进行积极的监测和治疗。
