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Ira N. Horowitz, MD; Kenneth Tai, MD

Arch Pediatr Adolesc Med. 2007;161(11):1048-1052.

Objective  To evaluate whether hypoalbuminemia on admission is a predictor of adverse outcome in critically ill children.

Design  Retrospective medical record review.

Setting  A 14-bed medical and surgical pediatric intensive care unit (PICU).

Participants  All patients admitted to the PICU from January 1, 1998, through December 31, 2000, under the care of the PICU team or trauma service and whose albumin level was measured were potential subjects. One hundred fifty-five patients were divided into 4 groups on the basis of age and appropriate albumin level for that age group. The groups of hypoalbuminemic patients were combined (hypoalbuminemia group) and compared with the combined group of patients with albumin levels above the reference cutoff (normal albumin level group).

Exposure  Serum albumin level.

Main Outcome Measures  Length of PICU and hospital stays, receipt and length of ventilatory support, survival, pediatric risk of mortality score, mortality risk, and number of organ failures.

Results  Controlling for mortality risk, the hypoalbuminemia group had a longer average stay in the PICU (8.08 vs 4.41 days; 95% confidence interval [CI] for difference, 1.02-6.32) and the hospital (11.36 vs 6.63 days; 95% CI for difference, 1.31-8.16) than did the normal albumin level group. The hypoalbuminemia group had a lower survival rate (odds ratio, 0.10; 95% CI, 0.02-0.46) and a higher number of organ failures (1.38 vs 0.65; 95% CI for difference, 0.40-1.04).

Conclusion  Admission hypoalbuminemia is a significant marker of morbidity and mortality in critically ill children.

Author Affiliations: Department of Pediatrics, Loyola University Medical Center, Maywood, Illinois. Dr Horowitz is now with Pediatric Critical Care, Morristown Memorial Hospital, Morristown, New Jersey.

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