Low albumin level in the emergency department: a potential independent predictor of delayed mortality in blunt trauma.
ABSTRACT Albumin is an abundant plasma protein with multiple physiologic functions, and low serum albumin levels have been associated with increased mortality in hospitalized patients. In a retrospective matched-pair study, we investigated whether emergency department (ED) albumin levels predict delayed mortality for patients initially stabilized after blunt trauma. Fifty-one hospital non-survivors who died more than 24 h after admission to a trauma center ED were matched by Injury Severity Score, type and location of injury, age, and gender with 51 survivors. All patients had serum albumin levels determined upon arrival in the ED. The non-survivors had a significantly lower admission albumin of 3.1 g/dL compared to 3.5 g/dL for survivors. Patients with albumin levels < 3.4 g/dL were 2.5 times more likely to die compared to patients with normal albumin levels. These preliminary results indicate that initial hypoalbuminemia in blunt trauma patients is an independent predictor of delayed mortality, suggesting that these patients require continued clinical vigilance and an aggressive search for evolving complications.
Article: Sickness behaviour pushed too far--the basis of the syndrome seen in severe protozoal, bacterial and viral diseases and post-trauma.[show abstract] [hide abstract]
ABSTRACT: Certain distinctive components of the severe systemic inflammatory syndrome are now well-recognized to be common to malaria, sepsis, viral infections, and post-trauma illness. While their connection with cytokines has been appreciated for some time, the constellation of changes that comprise the syndrome has simply been accepted as an empirical observation, with no theory to explain why they should coexist. New data on the effects of the main pro-inflammatory cytokines on the genetic control of sickness behaviour can be extended to provide a rationale for why this syndrome contains many of its accustomed components, such as reversible encephalopathy, gene silencing, dyserythropoiesis, seizures, coagulopathy, hypoalbuminaemia and hypertriglyceridaemia. It is thus proposed that the pattern of pathology that comprises much of the systemic inflammatory syndrome occurs when one of the usually advantageous roles of pro-inflammatory cytokines--generating sickness behaviour by moderately repressing genes (Dbp, Tef, Hlf, Per1, Per2 and Per3, and the nuclear receptor Rev-erbalpha) that control circadian rhythm--becomes excessive. Although reversible encephalopathy and gene silencing are severe events with potentially fatal consequences, they can be viewed as having survival advantages through lowering energy demand. In contrast, dyserythropoiesis, seizures, coagulopathy, hypoalbuminaemia and hypertriglyceridaemia may best be viewed as unfortunate consequences of extreme repression of these same genetic controls when the pro-inflammatory cytokines that cause sickness behaviour are produced excessively. As well as casting a new light on the previously unrationalized coexistence of these aspects of systemic inflammatory diseases, this concept is consistent with the case for a primary role for inflammatory cytokines in their pathogenesis across this range of diseases.Malaria Journal 11/2008; 7:208. · 3.19 Impact Factor
Article: The impact of admission hyperglycemia or hypoalbuminemia on need ventilator, time ventilated, mortality, and morbidity in critically ill trauma patients.[show abstract] [hide abstract]
ABSTRACT: The aim of this study was to evaluate the value of hypoalbuminemia or hyperglycemia as predictors for need ventilator and for weaning success in critically ill trauma patients. A single center, retrospective trial was done on 600 trauma patients = or >16 years old admitted for three or more days to the intensive care unit. Patients were classified into five different groups according to the reason for respiratory failure. The subsequent parameters were noted: serum albumin and glucose concentration, Acute Physiology and Chronic Health Evaluation III score, need ventilator, ventilator days, and fluid balance. The initial mean serum glucose concentration was 9.3 (167.4) +/- 0.2 (3.6 mg/dl) mmol/L and the initial mean serum albumin concentration was 30.2 (3.02) +/- 0.02 (0.2 g/dl) g/L. Even though the circulating albumin concentration was considerably lower and serum glucose concentration was significantly higher in ICU nonsurvivors than in ICU survivors, neither albumin (r=-0.031, p=0.23) nor blood glucose concentration (r=0.050, p=0.11) on ICU admission was a predictor of the duration of mechanical ventilation. The profile of albumin and glucose concentration changes was dissimilar between weaned and mechanical ventilation-dependent patients. An increase of 5 g/L (0.5 g/dl) in serum albumin concentration multiplied the relative success probability by 1.10. Patients with serum albumin concentration less than 30.3 (3.03 g/dl) g/L were 1.2 times more likely to need ventilator than normo-albuminemic patients (relative risk 1.2, 95% confidence interval 1.06-1.31). The risk of need mechanical ventilation did not increase with blood glucose concentration more than 11 mmol/L (200 mg/dl). These results suggest that albumin and blood glucose are possible indexes of the metabolic status of the trauma patient, which could be essential in deciding the need ventilator and weanable status of the patients who are mechanically ventilated for extended periods of time.Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 03/2009; 15(2):120-9. · 0.33 Impact Factor