Does Hypoalbumenemia at Presentation Increases Cumulative Fluid Balance and Vasopressors Requirement in Critically Ill Patients? A Prospective Randomised Study

BACKGROUND: Serum Albumin (SA) is an independent predictor of mortality.(1) Recent studies also showed that the predictive value of SA at admission has been shown for mortality in patients admitted to an ICU patients.(2) Therefore, the study has been conducted to determine the effect of SA at admission to the intensive care unit (ICU) on cumulative fluid balance & cumulative dose of noradrenaline during the first 24 & 48 hrs of ICU stay. METHODS: Eighty patients were randomised into 2 groups; Gr A SA <3 mg/dL & Gr B SA >=3 mg/dL. The patients in the two groups were observed and compared in terms of their demographic variables, lactate level, APACHE scores, cumulative fluid balance at 24 and 48 hours, cumulative dose of noradrenaline and of vasopressin. OBJECTIVES: albumin could reduce the need for fluid, vasopressors and inotropes support. RESULT: The two groups were comparable in regards to their demographic variables, Apache scores and initial lactate level. Cumulative fluid balance at 24 hrs (Gr A: 1.8 +/– 0.46; Gr B: 1.27 +/– 0.2981; p<0.0001) & at 48 hrs (Gr A: 1.40 +/– 0.51; Gr B: 1.12 +/– 0.38; p< 0.016) were significantly higher in Gr A. Requirement of noradrenaline was significantly high in Gr A at 24 hrs (Gr A 2416+/– 253; Gr B 1499+/– 589.77; p<0.0001) and 48hrs (Gr A 1353.3 +/– 320; Gr B; 854 +/– 371.63; p<0.0001). Requirement of vasopressin in Gr A 8 out of 40 patients over 48 hrs & 17 out of 40 patients in Gr B over 48 hrs which was significantly different. CONCLUSION: Critically ill patients with hypoalbumenemia require significantly high fluids & vasopressors as compared to patients with normal level of serum albumin. Our observations have to be validated in another large cohort.