Abstract
Background There is ambiguity in the literature regarding hypoalbuminemia as a cause of extravascular lung water and acute respiratory distress syndrome (ARDS) outcomes. The aim of the study was to determine if low serum albumin on admission leads to lung deaeration and higher lung ultrasound score (LUSS) in ARDS patients. Patients and Methods. It was a prospective observational study in which 110 ARDS patients aged between 18 and 70 years were recruited. Serum albumin level and lung ultrasound score were assessed on the day of ICU admission. Length of ICU stay and hospital mortality were recorded. Results The mean and standard deviation of serum albumin level in mild, moderate, and severe ARDS was 2.92 ± 0.65 g/dL, 2.91 ± 0.77 g/dL, and 3.21 ± 0.85 g/dL, respectively. Albumin level was not correlated to the global LUSS (Pearson correlation r −0.006, p=0.949) and basal LUSS (r −0.066, p=0.513). The cut-off value of albumin for predicting a prolonged length of ICU stay (≥10 days) in ARDS patients was <3.25 g/dL with AUC 0.623, p < 0.05, sensitivity of 86.67%, specificity of 45.45%, and 95% confidence interval (CI) [0.513–0.732], and on multivariate analysis it increased the odds of prolonged ICU stay by 8.9 times (Hosmer and Lemeshow p value 0.810, 95% CI [2.760–28.72]). Serum albumin at admission was not a predictor of mortality. LUSS on the day of admission was not useful to predict either a prolonged length of ICU stay or mortality. Basal LUSS contributed about 56% of the global LUSS in mild and moderate ARDS, and 53% in severe ARDS. Conclusion Serum albumin level was unrelated to LUSS on admission in ARDS patients. Albumin level <3.25 g/dL increased the chances of a prolonged length of ICU stay (≥10 days) but was not associated with an increase in mortality. LUSS on the day of admission could not predict either a prolonged length of ICU stay or mortality. This trial is registered with CTRI/2019/11/021857.
Highlights
Albumin contributes up to 80% of colloid osmotic pressure in the physiological state [1]
As our primary research question involved the variables serum albumin and global lung ultrasound score (LUSS), they were included in the multivariable analysis irrespective of the p value in the univariate analysis. us, we considered low serum albumin according to the cut-off value as per our receiver operating characteristic (ROC) analysis in the logistic regression model to predict the prolonged length of ICU stay and survival
Our findings were in contrast to those of the study done on head injury patients, where an albumin level
Summary
Albumin contributes up to 80% of colloid osmotic pressure in the physiological state [1]. It has been said that an intact glycocalyx with a particular minimum concentration of plasma proteins (albumin at least >1 g/dL) ensures adequate vascular endothelial barrier function [2, 3]. Ese concepts question the role of albumin in Critical Care Research and Practice altering lung air:fluid ratio, which can be accurately estimated from bedside lung ultrasound (LUS) [5]. Previous literature shows that extravascular lung water is increased in patients with low albumin in critically ill head injured patients, as evidenced by lung ultrasound, though neurologic pulmonary oedema could have been a confounding factor [6]. Bedside LUS has been proven to represent the extent of pulmonary ventilation; we used LUS to estimate the lung aeration [8]. Since literature is replete with dissensions regarding the role of albumin in worsening lung aeration, we wanted to determine if albumin was associated with lung deaeration
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