Department of Surgery, Tygerberg Hospital, South Africa.
Department of Paediatric Surgery, Inkosi Albert Luthuli Central Hospital, South Africa.
S Afr J Surg. 2024 Oct;62(3):40-44.
Serum albumin levels decrease following major trauma, for various reasons. We postulated that the serum albumin nadir (SAN) level would correlate negatively with severity of physiological insult.
This retrospective cohort study included all patients with abdominal trauma admitted to the Trauma Intensive Care Unit at Inkosi Albert Luthuli Central Hospital during 2017 and 2018.
Of the 87 patients, 70 (80.5%) were male. Mean age was 32.48 years (SD 11.65; range 12-73). Blunt trauma comprised 54 patients (62.1%). Median SAN level was 23 g/L (IQR 20-27; range 10-38). Median SAN level was not different between patients with blunt versus penetrating trauma ( = 0.69), patients in whom inotropic support had been used/not used ( = 0.0502), and no different between patients on the various modes of feeding at the time of SAN ( = 0.14). However, median SAN level was lower for patients with hollow visceral injury ( = 0.004), for patients who had undergone laparotomy ( = 0.0006), for those who had received damage control surgery ( = 0.001), those who had received blood transfusions ( = 0.03), and patients who died compared to survivors ( = 0.02). Univariate regression analysis revealed negative coefficients for the following in relation to SAN level: blood transfusion (-2.77; = 0.023), hollow viscus injury (-3.21; = 0.008), laparotomy (-4.5; < 0.001), damage control surgery (-3.60; = 0.02), day of SAN (-0.39; = 0.001), ICU length of stay (-0.12; = 0.002), and death (-3.27; = 0.03).
Greater physiological insults lead to lower levels of SAN. Serum albumin nadir level may therefore have value as a prognostic indicator in the acute trauma setting.
由于各种原因，重大创伤后血清白蛋白水平会下降。我们推测血清白蛋白最低点（SAN）水平与生理损伤的严重程度呈负相关。
本回顾性队列研究纳入了 2017 年至 2018 年期间在因卡塔祖鲁-纳塔尔省因科西·阿尔伯特·卢图利中央医院创伤重症监护病房收治的所有腹部创伤患者。
87 例患者中，70 例（80.5%）为男性。平均年龄为 32.48 岁（标准差 11.65；范围 12-73）。钝性创伤 54 例（62.1%）。中位 SAN 水平为 23g/L（IQR 20-27；范围 10-38）。在接受和未接受正性肌力支持的患者之间（ = 0.69）、在接受和未接受不同方式喂养的患者之间（ = 0.14）以及在接受和未接受开腹手术的患者之间（ = 0.0502），中位 SAN 水平无差异。然而，SAN 水平在空腔脏器损伤患者中较低（ = 0.004）、在接受剖腹手术的患者中较低（ = 0.0006）、在接受损伤控制性手术的患者中较低（ = 0.001）、在接受输血的患者中较低（ = 0.03），并且在死亡患者中低于存活患者（ = 0.02）。单变量回归分析显示，与 SAN 水平相关的负系数为：输血（-2.77； = 0.023）、空腔脏器损伤（-3.21； = 0.008）、剖腹手术（-4.5； < 0.001）、损伤控制性手术（-3.60； = 0.02）、SAN 日（-0.39； = 0.001）、ICU 住院时间（-0.12； = 0.002）和死亡（-3.27； = 0.03）。
更大的生理损伤导致 SAN 水平更低。因此，血清白蛋白最低点水平可能作为急性创伤患者的预后指标有一定价值。
