To the Editor: There is considerable evidence about association of hypoalbuminemia and/ or raised C-reactive protein (CRP) levels with higher mortality, organ failure and prolonged hospital stay in adults [1,2,3].
The role of hypoalbuminemia and raised CRP levels in predicting unfavorable prognosis in children with critical illness has not been extensively evaluated [4, 5]. PRISM and APACHE scores estimate the mortality risk, but require several costly investigations; unsuitable for resource-limited settings. Hence, we conducted a prospective observational study to determine if there was a significant difference in serum albumin and CRP levels or the CRP: albumin ratio between children with unfavorable prognosis (organ failure and/or death) and other children admitted to a Pediatric Intensive Care Unit (PICU).
Data of 100 participants [median age 49mo, IQR: 4–107mo; M:F = 1.27:1; median period of PICU stay 5d (range 1–35d, IQR:25)] was analyzed. Sixty-three children had organ failure (multiple organ failure in 31) and 28 died. Respiratory failure (39) was the commonest organ-system failure. The median levels of serum albumin and CRP at PICU admission were 3.30 g/dl (IQR: 2.82–3.76) and 15.56 mg/L (IQR: 4.85–63.26), respectively. The ROC curve for hypoalbuminemia as a predictor, had area under the curve value of 0.92. However, for raised CRP, the AUC was only 0.59.
Overall, the combination of hypoalbuminemia or raised CRP, had better sensitivity (96.83%) and specificity (91.89%) than either of them alone in determining unfavorable prognosis. The levels of serum albumin and CRP and the CRP: albumin ratio were significantly different between children with unfavorable prognosis and others.
The study has shown that a combination of hypoalbuminemia and/or raised CRP levels at admission is a sensitive and specific test for predicting unfavorable prognosis (organ failure and/ or death) and that a high CRP/albumin ratio is indicative of unfavorable prognosis in critically ill children. These valuable observations, if confirmed in larger studies, will provide simple, easily available and inexpensive tests for determining prognosis in resource-limited settings. Future research comparing these parameters with predictive scores to estimate mortality will be helpful.
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Previous Publication/ Presentation related to the study/ manuscript: The study findings were presented (e-poster) at the 19th National Conference of the Pediatric Intensive Care and Second Asian Congress of Pediatric Intensive Care, Chandigarh in November 2017, where it was adjudged as the Best e-poster.
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Bhandarkar, N., Save, S., Bavdekar, S.B. et al. Serum Albumin and C-Reactive Protein as Predictors of Adverse Outcomes in Critically Ill Children: A Prospective Observational Pilot Study. Indian J Pediatr 86, 758–759 (2019). https://doi.org/10.1007/s12098-019-02934-3
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DOI: https://doi.org/10.1007/s12098-019-02934-3