Preoperative hypoalbuminemia as a prognosis indicator in patients with surgical sepsis and septic shock.

Abstract

Introduction: Sepsis and septic shock are among the leading causes of morbidity and mortality worldwide. Hypoalbuminemia is commonly observed preoperatively and may serve as a prognostic factor for predicting severity of sepsis and septic shock.

Methodology: A cross-sectional, prospective descriptive study was conducted on 122 surgical adult patients diagnosed with sepsis or septic shock according to the Sepsis-3 criteria. All patients were admitted to the intensive care unit from April 2023 to May 2024.

Results: A total of 46 patients (37.7%) were diagnosed with sepsis and 76 patients (62.3%) developed septic shock. The septic shock group had significantly longer hospital stays compared to the sepsis group (7 days vs. 4 days, respectively) and higher mortality rates (52.6% vs. 10.9%, respectively). Hypoalbuminemia was present in 89.3% of all patients, with 22.1% patients having severe hypoalbuminemia. There was a significant difference in mortality rates between patients with hypoalbuminemia and normal albumin level (40.4% vs. 7.7%, respectively). The mortality rate of severe hypoalbuminemia patients was also higher (48.1%) than non-severe hypoalbuminemia (37.8%) and normal albumin levels (7.7%). The adjusted odds ratio for post-operative in-hospital death comparing patients with hypoalbuminemia and patients with normal albumin level was 8.12 [1.02-64.73]. A preoperative hypoalbuminemia with cutoff of 29.8 g/L was the prognostic factor for mortality with an area under the receiver operating characteristic curve (AUROC) of 67.3%, sensitivity of 78.6%, and specificity of 56.6%.

Conclusions: Preoperative albumin level was the potential prognostic indicator for severity and should be considered in the risk stratification model for patients with surgical sepsis and septic shock.