Serum Albumin Is Independently Associated with Persistent Organ Failure in Acute Pancreatitis.

Bicheng Cheng,Zarrin Basharat,Wandong Hong,Suhan Lin,Jingye Pan,Maddalena Zippi,Simon Stock,Mengtao Zhou,Wujun Geng

doi:10.1155/2017/5297143

Abstract

Background and Aims To investigate the association between serum albumin levels within 24 hrs of patient admission and the development of persistent organ failure in acute pancreatitis. Methods A total of 700 patients with acute pancreatitis were enrolled. Multivariate logistic regression and subgroup analysis determined whether decreased albumin was independently associated with persistent organ failure and mortality. The diagnostic performance of serum albumin was evaluated by the area under Receiver Operating Characteristic (ROC) curves. Results As levels of serum albumin decrease, the risk of persistent organ failure significantly increases (Ptrend < 0.001). The incidence of organ failure was 3.5%, 10.6%, and 41.6% in patients with normal albumin and mild and severe hypoalbuminaemia, respectively. Decreased albumin levels were also proportionally associated with prolonged hospital stay (Ptrend < 0.001) and the risk of death (Ptrend < 0.001). Multivariate analysis suggested that biliary etiology, chronic concomitant diseases, hematocrit, blood urea nitrogen, and the serum albumin level were independently associated with persistent organ failure. Blood urea nitrogen and the serum albumin level were also independently associated with mortality. The area under ROC curves of albumin for predicting organ failure and mortality were 0.78 and 0.87, respectively. Conclusion A low serum albumin is independently associated with an increased risk of developing of persistent organ failure and death in acute pancreatitis. It may also be useful for the prediction of the severity of acute pancreatitis.

Highlights

Though most patients with acute pancreatitis (AP) have a benign clinical course, approximately 10%–20% of patients develop persistent organ failure associated with significant mortality of at least 30% [1, 2]
Exclusion criteria included [21] patients that had developed organ failure before data collection, recurrent or not first-time pancreatitis, previous pancreatic surgery, ERCP or traumainduced pancreatitis, chronic pancreatitis, pancreatic cancer, pleural effusions preceding the development of AP, and pleural effusions resulting from concomitant diseases, patients with albumin infusion before data collection in our hospital, hypoalbuminemia due to malnutrition, chronic renal disease, albuminuria, hepatitis, bleeding/coagulation disorders, chronic alcoholism, and liver cirrhosis, and patients for whom completed data was unavailable
Decline in serum albumin level was associated with a decrease in hematocrit (P = 0.001), alanine aminotransferase (P = 0.001), glucose (P = 0.003), and blood urea nitrogen (BUN) (P < 0.001)

Summary

Introduction

Though most patients with acute pancreatitis (AP) have a benign clinical course, approximately 10%–20% of patients develop persistent organ failure (defined as organ failure lasting for ≥48 hours) associated with significant mortality of at least 30% [1, 2]. To investigate the association between serum albumin levels within 24 hrs of patient admission and the development of persistent organ failure in acute pancreatitis. Multivariate logistic regression and subgroup analysis determined whether decreased albumin was independently associated with persistent organ failure and mortality. Multivariate analysis suggested that biliary etiology, chronic concomitant diseases, hematocrit, blood urea nitrogen, and the serum albumin level were independently associated with persistent organ failure. A low serum albumin is independently associated with an increased risk of developing of persistent organ failure and death in acute pancreatitis. It may be useful for the prediction of the severity of acute pancreatitis

Objectives

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Results

Conclusion