Role of Microalbuminuria and Hypoalbuminemia as Outcome Predictors in Critically Ill Patients

Abstract

Background. Assessment of microalbuminuria and hypoalbuminemia can be used as a good tool for the prediction of the ICU outcome in critically ill patients. Purpose. To evaluate and compare the prognostic significance of microalbuminuria (albumin creatinine ratio (ACR)) and serum albumin level done on admission and after twenty-four hours for the critically ill patients. Methodology. Sixty ICU patients were involved in a prospective cohort study (mean age was 44.4 ± 16.7 years, and 78.3% were males). Patients were divided into 2 groups according to mortality (survivors and nonsurvivors) and were subjected to laboratory measurement of the mentioned biomarkers on admission and after twenty-four hours. Results. There were 34 patients (56.67%) in group A (survivors) and 26 patients (43.33%) in group B (nonsurvivors). Albumin creatinine ratio on admission (ACR1) and albumin creatinine ratio after 24 hours (ACR2) were significantly lower in survivors than nonsurvivors ( $P$ values were <0.001 for both). Serum albumin level after 24 hours of admission was significantly higher in survivors than nonsurvivors ( $P$ value 0.02) while admission serum albumin was not significantly different between both groups ( $P$ value was 0.1). There was a positive correlation between ACR2 and ICU stay and mechanical ventilatory support with a strong positive correlation with the use of vasopressor therapy (r: 0.35, 0.58, and 0.73, respectively). $P$ values were 0.005, <0.0001, and <0.0001, respectively. There was a positive correlation between ACR2 with APACHE II and SOFA scores (r: 0.46 and 0.43, respectively); $P$ values were 0.001 and <0.0001, respectively. There was a moderate negative correlation between serum albumin on admission and after 24 hours and the duration of mechanical ventilation (r: −0.4 and −0.39, respectively) ( $P$ values were 0.001 and 0.002, respectively). By Cox regression analysis, two parameters were found to be an independent predictor of mortality in ICU patients which were age and using vasopressor treatment ( $P$ values = 0.01 and <0.001), while the other parameters were not independent predictors of mortality ( $P$ values were more than 0.05). Conclusions. Microalbuminuria on admission and after 24 hours of ICU admission could be a good predictor of mortality in critically ill patients. The serum albumin level after 24 hours of admission can predict poor outcomes in critically ill patients.