Kritik hastalarda serum albümin seviyelerinin mortalite öngörüsündeki gücü

Abstract

Amaç: Yoğun bakımda (YB) yatan hastaların komorbiditeleri ve kritik durumları göz önüne alındığında, bu hastalar için prognoz ve mortalite prediksiyonu ve buna göre tedavilerinin düzenlenmesi hastalar için hayati önem taşımaktadır. Azalan serum albümin düzeyi (ASA), olumsuz klinik sonuçlarla ilişkilidir. Bu çalışmayı, yoğun bakım ünitesinden (YBÜ) elde edilen verilere dayanarak kritik hastalarda ASA'nin prognostik değerini ve yaşla ilişkisini değerlendirmek için tasarladık. Gereç ve Yöntem: Akdeniz Üniversitesi Hastanesi Dahiliye YB ünitesinde Haziran 2022- Aralık 2023 tarihleri arasında takip edilen, hastaların verileri retrospektif olarak incelendi. YB kabulden itibaren ilk 24 saat içinde ölçülen Albumin, CRP, SOFA ve APACHE-II skorları kaydedildi. Albumin değerler arasındaki değişimi ifade etmek için Delta Albumin ifadesi kullanıldı. Elde edilen verilerin yaş ile ilişkisine bakıldı, sağ kalan ve kaybedilen hasta gruplarında karşılaştırıldı. Bulgular: Çalışmaya 300 hasta dahil edildi. Albumin düzeyleri, hem sağkalım grubunda hem de eksitus grubunda çıkışta yatış anına göre anlamlı derecede düşük bulundu ( her ikisi için de p<0,001). Albumin düzeylerindeki değişim yaş, cinsiyet, SOFA ve APACHE değişimlerinden bağımsız olarak yoğun bakım mortalitesi ile anlamlı olarak ilişkili bulundu. Daha düşük albümin seviyeleri, daha kötü sağkalım ile ilişkiliydi (HR:0,80; %95 GA:0,69-0,92 ve p=0,001). Sonuç: Albumin düzeylerindeki değişim yaş, cinsiyet, SOFA ve APACHE değişimlerinden bağımsız olarak yoğun bakım mortalitesi ile anlamlı olarak ilişkili bulundu.

Keywords

• Yoğun bakım
• Albümin seviyesi
• Mortalite

The power of serum albumin levels in predicting mortality in critical patients

Abstract

Aims: Given the presence of comorbidities and critical illnesses in patients admitted to the intensive care unit (ICU), it is imperative to accurately forecast their prognosis and mortality in order to effectively plan and administer their therapies. Decreased serum albumin level is associated with adverse clinical outcomes. We designed this study to evaluate the prognostic value of decreased serum albumin level and its association with age in critically ill patients based on data obtained from the intensive care unit (ICU). Methods: Data of patients followed between June 2022 and December 2023 in the Internal Medicine ICU of Akdeniz University Hospital were retrospectively reviewed. Albumin, C-reactive protein (CRP), Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores were documented within the initial 24 hours following admission to the ICU. Delta Albumin expression was used to express the changes between albumin values. The relationship between the obtained data and age was examined and compared between the surviving and deceased patient groups. Results: 300 patients were included in the study. Albumin levels were significantly lower at admission compared to discharge in both the survival and deceased groups (both p<0.001). Changes in albumin levels were significantly associated with ICU mortality independently of age, gender, SOFA, and APACHE changes. Lower albumin levels were associated with worse survival (Hazard ratio: 0.80; 95% Confidence interval: 0.69-0.92; p=0.001). Conclusion: Changes in albumin levels were significantly associated with ICU mortality independently of age, gender, SOFA, and APACHE changes.

Keywords

• Intensive care
• Albumin levels
• Mortalitiy

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