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Hypoalbuminemia: incidence and its impact on acute respiratory distress syndrome and 28-day outcome in trauma patients

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Abstract

Objective

This prospective observational study explored the effect of early onset hypoalbuminemia (EOH) on the development of adult respiratory distress syndrome (ARDS) in orthopedic trauma victims.

Methods

Serum albumin levels were measured for the initial 7 days of injury for adult trauma patients (18–65 years). Patients were recruited into group A (any serum albumin value < 3.5 mg/dl) and group B (all serum albumin ≥ 3.5 mg/dl), based on serum albumin values. Patients were followed for the development of ARDS and outcome until 28 days. The primary outcome of the study was to explore the effects of EOH on ARDS.

Results

EOH (any serum albumin value < 3.5 g/dl within 7 days of injury) was present in 205/386 (53.1%) patients. The majority of 174/205 (84.9%) patients had EOH by the fourth day after the injury, with the mean time for development of EOH being 2.15 ± 1.87 days. ARDS manifested in 87/205 (42.4%) and 15/181 (8.3%) patients in group A and group B, respectively (p < 0.001). EOH had 8.2 times greater odds of ARDS (OD 8.2 95% CL 4.7–14.0, p = 0.000). The mean time for the onset of ARDS was 5.63 ± 2.62 days. No statistically significant causal relationship occurred between the onset of EOH and the development of ARDS (Pearson’s correlation coefficient = 0.14, p = 0.16). At serum albumin cutoff concentrations of 3.4 gm/dl on D1 (AUC 0.68, 95% CI: 0.61–0.74, p = 0.000), ARDS may be anticipated in 62.8% of patients. The commencement of ARDS was independently correlated with EOH (p = 0.000), Respiratory rate on admission (p = 0.000), inotrope use (p = 0.000), and soft tissue injury (p = 0.000) (R2 = 0.466). The odds of 28-day all-cause death were 7.7 times higher in EOH (OD 7.7 95% CL 3.5–16.7, p = 0.00) and 9 times higher in ARDS (OD 9 95% CL 4.9–16.16, p = 0.00).

Conclusion

EOH is a frequent occurrence and has a strong influence development of ARDS and 28-day mortality in trauma patients.

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Data availability

The detailed Data are available from the corresponding author on request only due to ethical, legal, commercial or research reasons.

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Authors and Affiliations

  1. PGIMER: Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India

    Mandeep Kumar, Kajal Jain, Rajeev Chauhan, Shyam Charan Meena, Ankur Luthra, Haneesh Thakur, Ajay Singh, Revathi Nair & Rekha Gupta

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Kumar, M., Jain, K., Chauhan, R. et al. Hypoalbuminemia: incidence and its impact on acute respiratory distress syndrome and 28-day outcome in trauma patients. Eur J Trauma Emerg Surg 49, 2305–2314 (2023). https://doi.org/10.1007/s00068-023-02318-5

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