Frequency of Hypoalbuminaemia in Preterm Neonates With Sepsis and Its Relation With Mortality

Abstract

Background: Neonatal sepsis is a leading cause of morbidity and mortality in preterm infants, who are particularly vulnerable due to their immature immune systems. Hypoalbuminemia, a common biochemical abnormality in these neonates, may reflect the severity of infection and the systemic inflammatory response, potentially serving as a prognostic marker for mortality. Objective: This study aimed to determine the frequency of hypoalbuminemia in preterm neonates with sepsis and to evaluate its sensitivity, specificity, and diagnostic accuracy in predicting mortality within the neonatal period. Methods: A cross-sectional validation study was conducted at the Department of Paediatrics, Combined Military Hospital, Rawalpindi, from January 2023 to April 2024. A total of 140 preterm neonates with sepsis were included. Neonates with primary liver conditions, significant congenital anomalies, or nephrotic syndrome were excluded. Serum albumin levels were measured upon study enrollment, with hypoalbuminemia defined as a serum albumin level <2.5 g/L. Mortality was monitored for up to 28 days of life. Data were analyzed using SPSS version 25. Quantitative variables were expressed as means/medians, while qualitative variables were presented as frequencies and percentages. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated, and a receiver operating characteristic (ROC) curve was plotted to determine the optimal cut-off value. Results: Hypoalbuminemia was observed in 57 (40.7%) of the neonates. Mortality occurred in 36 (25.7%) cases. Hypoalbuminemia was significantly associated with mortality (p<0.001). The sensitivity, specificity, and diagnostic accuracy of hypoalbuminemia in predicting mortality were 77.78%, 72.12%, and 73.57%, respectively. The optimal serum albumin cut-off value for predicting mortality was 2.45 g/L, with a sensitivity of 73.1% and a specificity of 77.8%. Conclusion: Hypoalbuminemia is a significant predictor of mortality in preterm neonates with sepsis, demonstrating reasonable diagnostic accuracy. Monitoring serum albumin levels may be valuable in risk stratification and early identification of high-risk neonates. Further studies are recommended to validate these findings in larger cohorts and to explore potential therapeutic interventions.