Prevalence and effect of hypoalbuminemia in patients admitted to Addis Ababa burn, emergency and trauma hospital intensive care unit: a one year crossectional study

Abstract

ABSTRACT Background- Hypoalbuminemia is a frequent and early biochemical derangement in critically ill patients. And it is considered as a marker of disease severity and predictor of increased morbidity and mortality. Even though hypoalbuminemia is a significant problem in critical ill patients well studied information in intensive care units in developing countries is relatively rare. Objectives - The objective of this study is to investigate prevalence of hypoalbuminemia and its association with disease severity and clinical outcome of illness in critically ill patients admitted to AaBET ICU, from May 1, 2020, through May 31, 2021 Methods - One year cross sectional study was conducted at AaBET intensive care unit (ICU). The study was conducted in the Intensive Care Unit of Addis Ababa Burn Trauma and Emergency hospital. All patients admitted to the AaBET ICU from May 1, 2020, through May 31, 2021, whose albumin level was measured are study population and minimum sample size calculated was 176. And total cases in the study period was 274 among this 181subjects were included, 93 subjects were excluded. Data was collected by retrospective medical record review using a structured questionnaire by 2 trained residents. Data was entered to Epi-info version 3.5.3 and exported to SPSS Version 24 for analysis. Bivariate and multivariate logistic regressions were used to analyze the association between dependent and independent variables and P-value <0.05 at 95% CI was declared statistically significant association. Results: From the total of 181 cases majority 150 (82.9%) were male and 31 (17.1%) were females. The mean age was 35.1 years and majority 123 (68%) are in age group 2564 years. Major reason for admission to the ICU were Trauma 147(81.2%) (Majority 107(81.1%) have Brain injury), followed by Medical 22(12.2%). From the total cases the majority has hypoalbuminemia after ICU admission 164 (90.6%) after 48 hrs of admission to ICU and 177 (97.8%) at discharge and mean sr albumin level at 48hrs of admission and at discharge is 2.7g/dl (σ =0.74) and 2.05g/dl (σ =0.67) respectively. Based on severity 82 (45.3%) of patient’s have sever hypoalbuminemia (< 2.5g/dl) and 82 (45.3%) were in moderate range between 2.6g/dl - 3.5g/dl after 48hr of ICU admission. And at discharge majority were in sever range, 125 (69.1%). In Bivariate analysis, female Patient 2.56 times [(AOR=2.56) 95% CI (1.14, 5.76)] more likely have death than male patients. And medical patients has more mortality than trauma and nontraumatic surgical cases with [(AOR = 2.77) 95% CI (1.10, 6.96)]. Albumin level after 48hr of admission and albumin level immediately before discharge were negatively associated death. And low serum albumin level after 48 hrs with [p value =0.048, 95% CI, (0.055-0.990)] and at discharge with [p value =0.00, 95% CI, (0.075-0.468)] negatively associate with HAP but no association with prolonged MV and ICU stay. In the multivariate analysis, female Patient 4.7 times [AOR=4.7) 95% CI (1.68, 13.1)] more likely have death than male patients. Conclusion: Hypoalbuminaemia is a common finding in critically ill patients and and low albumin level will predispose patients to hospital acquired infections and increase mortality. Keywords: prevalence, outcome, hypoalbuminemia , critical ill, Intensive care unit, AaBET hospital