Ali Muhammad Ammar, Raza Muhammad Tahir, Majeed Saqib, Tahir Urooj, Ahmad Waseem, Tahir Mohid Bin, Ali Rana Shahzaib, Afzal Aleeza, Hasan Muhammad Qasim, Hassan Muhammad, Liaquat Sana, Khan Tayyab Mumtaz
Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK.
Emergency, University Hospitals Coventry and Warwickshire, Coventry, GBR.
Cureus. 2024 Oct 14;16(10):e71411. doi: 10.7759/cureus.71411. eCollection 2024 Oct.
Background Sepsis is a critical and potentially fatal medical condition characterized by significant illness and death rates. Early recognition and assessment of sepsis severity are vital for its optimal management. Determination of its severity by Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II, is quite a complex process as these score systems require complex and costly investigations. Therefore, this study was designed to determine the predictive capacity of serum albumin levels for the severity of sepsis in intensive care unit (ICU) patients. Methods This cross-sectional study was carried out on 201 ICU-admitted patients with diagnosed sepsis at Benazir Bhutto Hospital (BBH), Rawalpindi, Pakistan from March 2022 to April 2023. Recruitment of patients was performed through consecutive sampling and predefined inclusion and exclusion criteria. Prior to the data collection, ethical approval and informed consent were obtained. Data was gathered via a self-designed proforma. SOFA score was applied for the determination of the severity of sepsis. Patients were categorized into three groups based on sepsis severity (SOFA score). Data analysis was done in the Statistical Package for the Social Sciences (SPSS) version 25. Descriptive and inferential statistics compared study variables. Pearson's correlation and a simple linear regression model were used to assess the relationship between serum albumin levels and sepsis severity and the predictive capacity of serum albumin levels for sepsis severity respectively. The statistical significance of the p-value was set at less than 0.05. Results Among the 201 patients, 64 (31.84%) had sepsis, 98 (48.75%) had severe sepsis, and 39 (19.41%) had septic shock. Hypoalbuminemia was present among 119 (59.20%) patients while 82 (40.80%) patients had normal albumin levels. Significant differences were found in the total bilirubin, serum creatinine, platelet count, PaO2/FiO2 ratio, mean arterial pressure, Glasgow Coma Scale score, SOFA score, serum albumin level, and the prevalence of normal and low albumin levels across three study groups (p < 0.05). Pearson's correlation analysis showed a strong negative correlation between serum albumin level and SOFA score (correlation coefficient (r) = -0.78, p = 0.001). Linear regression analysis confirmed an inverse relationship between serum albumin levels and SOFA scores (beta coefficient = -2.70, p = 0.002). Conclusions In the present study, serum albumin level was noted as a reliable predictor of sepsis severity in ICU patients. Lower serum albumin levels were associated with higher SOFA scores, indicating more severe sepsis. This study supports the use of serum albumin as a simple and cost-effective biomarker for early identification of sepsis severity, particularly in resource-limited settings.
脓毒症是一种危急且可能致命的医学病症,具有较高的发病率和死亡率。早期识别和评估脓毒症的严重程度对于其最佳治疗至关重要。通过序贯器官衰竭评估(SOFA)和急性生理与慢性健康状况评估(APACHE)II来确定其严重程度是一个相当复杂的过程,因为这些评分系统需要复杂且昂贵的检查。因此,本研究旨在确定血清白蛋白水平对重症监护病房(ICU)患者脓毒症严重程度的预测能力。
本横断面研究于2022年3月至2023年4月在巴基斯坦拉瓦尔品第贝娜齐尔·布托医院(BBH)对201名确诊脓毒症的ICU住院患者进行。通过连续抽样和预先定义的纳入及排除标准招募患者。在数据收集之前,获得了伦理批准和知情同意。数据通过自行设计的表格收集。应用SOFA评分来确定脓毒症的严重程度。根据脓毒症严重程度(SOFA评分)将患者分为三组。在社会科学统计软件包(SPSS)25版中进行数据分析。描述性和推断性统计比较了研究变量。分别使用Pearson相关性分析和简单线性回归模型评估血清白蛋白水平与脓毒症严重程度之间的关系以及血清白蛋白水平对脓毒症严重程度的预测能力。p值的统计学显著性设定为小于0.05。
在201名患者中,64名(31.84%)患有脓毒症,98名(48.75%)患有严重脓毒症,39名(19.41%)患有脓毒性休克。119名(59.20%)患者存在低白蛋白血症,而82名(40.80%)患者白蛋白水平正常。在三个研究组中,总胆红素、血清肌酐、血小板计数、PaO2/FiO2比值、平均动脉压、格拉斯哥昏迷量表评分、SOFA评分、血清白蛋白水平以及正常和低白蛋白水平的患病率存在显著差异(p < 0.05)。Pearson相关性分析显示血清白蛋白水平与SOFA评分之间存在强烈的负相关(相关系数(r)= -0.78,p = 0.001)。线性回归分析证实血清白蛋白水平与SOFA评分之间存在负相关关系(β系数 = -2.70,p = 0.002)。
在本研究中,血清白蛋白水平被认为是ICU患者脓毒症严重程度的可靠预测指标。较低的血清白蛋白水平与较高的SOFA评分相关,表明脓毒症更严重。本研究支持将血清白蛋白作为一种简单且具有成本效益的生物标志物,用于早期识别脓毒症严重程度,特别是在资源有限的环境中。