Role of Serial Estimation of Serum Albumin Level as a Prognostic Factor in Sepsis Patients

Background: The high morbidity and mortality rates of sepsis contribute to a significant global healthcare burden. The mortality rate is still high because of the delay in diagnosis caused by the absence of trustworthy diagnostic procedures, despite the significant advancements in therapeutic choices. Endothelial dysfunction and an increase in systemic capillary permeability are caused by the strong activation of the inflammatory cascade in sepsis. The kidney excretes more albumin in the urine due to capillary leaks in the glomerulus and a lack of barrier integrity. The main aim of this study is to evaluate whether there is a quantitative relationship between serum albumin levels and the risk of mortality, as well as the function of serial monitoring of serum albumin levels as a predictor of mortality and morbidity in sepsis patients admitted to the intensive care unit. Method: Present study was conducted in ICU Medicine department of Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar from July 2023 to June 2024 on 140 sepsis patients who admitted during this study period. On the first day of sepsis diagnosis, as well as on days three and five, the serum albumin levels of all the enrolled patients were assessed after a thorough evaluation. Throughout their hospital stay, patients were monitored, and their outcome that is, whether they died or survived was noted. SPSS (statistical product and service solutions) software version 24.0 was used to analyze the data after it was entered into an MS Excel sheet. Results: There were two groups of 140 patients selected for the study: survivors and non-survivors. On the first day, the survivor group’s mean serum albumin level was 3.72 g/dl (±0.278), while the non-survivor group’s was 3.11 g/dl (±0.247). On day three, the survivor group’s mean serum albumin level was 3.17 g/dl (±0.248), while the non-survivor group’s was 2.65 g/dl (±0.172). On day five, the survivor group’s mean serum albumin level was 2.72 g/dl (±0.25), while the non-survivor group’s was 2.32 g/dl (± 0.144). According to the unpaired t test, the difference in mean serum albumin on days 1, 3, and 5 was statistically significant (p value ≤0.001). Survivors’ mean blood albumin levels decreased from 3.72 g/dl to 2.72 g/dl between days 1 and 5. It ranges from 3.11 to 2.32 g/dl in non-survivors. Conclusion: According to this study, a patient with sepsis who has a serum albumin level below 3.5 gm/dl for all three days has a bad prognosis. Serum albumin levels gradually decreased in both the survivor and non-survivor groups starting on day 1, but a drop below 3.0 gm/dl was linked to a greater death rate. It implies that the prognosis of the sepsis patient in terms of mortality is influenced by the speed at which serum albumin drops below the normal level. The clinical evaluation of sepsis patients, who are at risk of a bad prognosis even in locations with little resources, may benefit from serum albumin testing, which is less expensive and can be measured serially.