Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Via Garziere, 43, 36014, Santorso, Italy.
Department of Emergency Medicine, Hospital of Merano-Meran (SABES-ASDAA), Merano-Meran, Italy.
Intern Emerg Med. 2023 Nov;18(8):2407-2417. doi: 10.1007/s11739-023-03387-5. Epub 2023 Aug 10.
Assessing the evolutive risk of septic patients in the emergency department (ED) is very complex. Predictive tools are available, but at an early stage, none of them can detect the tissue microvascular alterations underlying the septic process. Hypoalbuminemia is present in critically ill patients in the ICU, and some early indications also suggest its early role in septic patients.
To investigate the role of serum albumin concentration in predicting 30-day mortality among patients with sepsis at their first evaluation in the ED.
Prospective observational study enrolling all patients with sepsis evaluated consecutively at the ED of the Merano Hospital from January to December 2021. The serum albumin concentration on admission was measured immediately upon patient arrival. A multivariate logistic regression model adjusted for possible confounders assessed the association between albumin levels at admission and 30-day mortality. Kaplan-Meier survival analysis was used to evaluate 30-day mortality between groups, and receiver operating characteristic (ROC) curve analysis was used to assess the discriminatory ability of albumin in predicting mortality.
459 patients with community-acquired sepsis were included. 17% (78/459) of patients died within 30 days. In surviving patients, the mean albumin level was 3.6 g/dL (SD 0.5), while among non-survivors it was 3.1 g/dL (SD 0.4), p < 0.001. The area under the ROC was 0.754 (95% CI 0.701-0.807). Multivariate analysis found that albumin was an independent risk factor for 30-day mortality, with an adjusted risk ratio of 2.991 (95% CI 1.619-5.525, p < 0.001) for each 1 g/dL decrease in albumin.
Serum albumin concentration measured during initial ED assessment can be a useful prognostic marker of 30-day mortality in septic patients.
评估急诊科（ED）脓毒症患者的进化风险非常复杂。有预测工具，但在早期阶段，没有一种工具可以检测到脓毒症过程中潜在的组织微血管改变。低蛋白血症在重症监护病房（ICU）的危重病患者中很常见，一些早期迹象也表明其在脓毒症患者中的早期作用。
探讨血清白蛋白浓度在预测 ED 首次评估时脓毒症患者 30 天死亡率中的作用。
前瞻性观察研究纳入 2021 年 1 月至 12 月在梅拉诺医院 ED 连续评估的所有脓毒症患者。入院时立即测量入院时的血清白蛋白浓度。多变量逻辑回归模型调整了可能的混杂因素，评估了入院时白蛋白水平与 30 天死亡率之间的关联。Kaplan-Meier 生存分析用于评估组间 30 天死亡率，受试者工作特征（ROC）曲线分析用于评估白蛋白预测死亡率的区分能力。
共纳入 459 例社区获得性脓毒症患者。30 天内死亡的患者占 17%（78/459）。在存活患者中，白蛋白的平均水平为 3.6g/dL（SD 0.5），而非存活患者为 3.1g/dL（SD 0.4），p<0.001。ROC 曲线下面积为 0.754（95%CI 0.701-0.807）。多变量分析发现白蛋白是 30 天死亡率的独立危险因素，白蛋白每降低 1g/dL，调整后的风险比为 2.991（95%CI 1.619-5.525，p<0.001）。
ED 初始评估时测量的血清白蛋白浓度可以作为脓毒症患者 30 天死亡率的有用预后标志物。
