Serum Albumin as Independent Predictor In Determining The Outcome Of Traumatic Brain Injury

Abstract

Context: Serum albumin is the major protein of the human plasma, accounting for about 60% of the total plasma protein. Serum albumin levels tend to decline in the plasma due to injury or infection independent of nutritional status. Serum albumin consumption increases in a state of stress. Reduction in serum albumin occurs with intracranial haemorrhages. In a patient with severe head injury, there is a significant decline in serum albumin leading to hypoalbuminemia. Serum albumin can be used as an outcome marker in various critical illnesses, including traumatic brain injury. Aim: To determine that serum albumin is an independent predictor affecting the outcome of patients with severe traumatic brain injury over a 6-month duration Settings and design: This was conducted as prospective cohort study in two neurosurgical centres in the East Coast of Malaysia from June 2020 to June 2021 Subjects and methods: A total of fifty-five patients were admitted to our emergency intensive care, or high dependency unit with varying degrees of severe head injuries. Forty patients fulfilled the inclusion criteria of our study and were recruited for data collection and further analysis. Their serum albumin levels were drawn, analysed, and recorded. Statistical analysis used: Descriptive, univariate and multivariate analyses using Multiple Logistic Regression model were done using SPSS version 26.0. Results: Average age for patients in this study was 42 years old. 87.5% of patients involved in this study were male, while the remaining 12.5% were female. The ethnicity of the majority of patients were Malays (77.5%) and the other ethnicities involved were Chinese, Indians and Bangladeshi, with a total of 22.5%. Multiple intracranial injuries were suffered by 57.5% of our study population, Subdural Hemorrhage, Extradural Hemorrhage, Contusional bleed, and Diffuse Axonal Injury were seen respectively in 20%, 10% 7.5% and 5% of the study population. At six months, the unfavourable outcome for serial serum albumin in patients with severe head injury patients was 62.5%, while the favourable outcome was 37.5%. Serum albumin of 30 g/L or less than 30g/L at day 1,3 and 5 post-trauma was noted to have unfavourable outcomes compared to serum albumin level of more than 30g/L. Conclusion: Serum albumin is an independent predictor of outcome in severe TBI patients. However, larger prospective studies are required to verify these findings.