Is hypoalbuminemia a predictor for mortality in Tracheostomized patients transferred from intensive care unit to palliative service?
Article Sidebar
Main Article Content
Abstract
Objective: Tracheostomy is a bedside surgical procedure that is frequently performed in intensive care units. It allows patients who need a long-term mechanical ventilator to be transferred from intensive care through a home-type mechanical ventilator. In this study, we aimed to evaluate the relationship between serum albumin levels before hospitalization and discharge or before exitus and mortality in patients who were transferred to the palliative care service with a home type mechanical ventilator by opening a tracheostomy in the intensive care unit.
Material-Method: 110 patients with tracheostomy and home ventilator who were transferred from the intensive care unit to the palliative care service between 01/05/2018-11/05/2021 were analyzed retrospectively. Patients' age, gender, diagnosis of hospitalization (chronic obstructive pulmonary disease (COPD) / malignancy), presence of comorbidity, number of days of tracheostomy (on which day the tracheostomy was opened in the intensive care unit admission), Glasgow Coma Scale (GCS) and intensive care severity scores (Acute Physiology and Chronic Health Evaluation Score (APACHE II), Sequential Organ Failure Assessment (SOFA), hospitalization serum albumin (g/dl) values, and recent serum albumin values of those who had exitus or discharge before discharge or exitus were examined retrospectively.
Results: The study's results showed that the 28-day mortality relation with old age is statistically significant. There is a statistically significant relationship between the high SOFA score at admission to the intensive care unit and 28-day mortality. There is no statistically significant difference between gender, presence of comorbidity in patients with COPD and malignancy hospitalization, GCS, APACHE II showing intensive care severity score, number of days of tracheostomy and 28-day mortality. There is a statistically significant difference between the intensive care hospitalization serum albumin value and the low serum albumin values before discharge/decease and the mortality rate of 28 days.
Conclusion: In the analysis of this study, it was observed that old age and high SOFA score increased 28-day mortality in tracheostomized patients transferred to the palliative service in the intensive care unit. In addition, the low level of albumin values in intensive care hospitalization and before discharge/death also increases mortality.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Accepted 2023-01-31
Published 2023-02-08
References
Devrim Aydın. Relationship between the level of serum albumin and mortality of patients hospitalized in internal intensive care clinic of Trakya University Medical school-2015.
Boldt J, Suttner S. Plasma substitutes. Minerva Anestesiol. 2005 Dec;71(12):741-58.
American Thoracic Society. Evidence-based colloid use in the critically ill: American Thoracic Society Consensus Statement. Am J Respir Crit Care Med. 2004 Dec 1;170(11):1247-59. https://doi: 10.1164/rccm.200208-909ST.
Sullivan DH, Roberson PK, Bopp MM. Hypoalbuminemia 3 months after hospital discharge: significance for long-term survival. J Am Geriatr Soc. 2005 Jul;53(7):1222-6. https://doi: 10.1111/j.1532-5415.2005.53369.x.
Vincent JL, Dubois MJ, Navickis RJ, Wilkes MM. Hypoalbuminemia in acute illness: is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials. Ann Surg. 2003 Mar;237(3):319-34. https://doi: 10.1097/01.SLA.0000055547.93484.87.
Zimmerman JE, Kramer AA, McNair DS, Malila FM. Acute Physiology and Chronic Health Evaluation (APACHE) IV: hospital mortality assessment for today's critically ill patients. Crit Care Med. 2006 May;34(5):1297-310.https://doi: 10.1097/01.CCM.0000215112.84523.F0.
Vincent JL. Relevance of albumin in modern critical care medicine. Best Pract Res Clin Anaesthesiol. 2009 Jun;23(2):183-91. https://doi: 10.1016/j.bpa.2008.11.004.
Murphy TJ, Paterson HM, Kriynovich S, Zang Y, Kurt-Jones EA, Mannick JA,et al. Linking the "two-hit" response following injury to enhanced TLR4 reactivity. J Leukoc Biol. 2005 Jan;77(1):16-23. https://doi: 10.1189/jlb.0704382.
Kaneko A, Kido T, Yamamoto M, Kase Y, Washizawa N, Aburada M, et al. Intestinal anastomosis surgery with no septic shock primes for a dysregulatory response to a second stimulus. J Surg Res. 2006 Aug;134(2):215-22. https://doi: 10.1016/j.jss.2006.01.003.
Robinson Y, Hostmann A, Matenov A, Ertel W, Oberholzer A. Erythropoiesis in multiply injured patients. J Trauma. 2006 Nov;61(5):1285-91. https://doi: 10.1097/01.ta.0000240969.13891.9b.
Muir JF, Cuvelier A. Evaluation of candidates for long-term ventilation. Respir Care Clin N Am. 2002 Sep;8(3):405-18, vi. https://doi: 10.1016/s1078-5337(02)00031-x.
Pollock CA, Ibels LS, Zhu FY, Warnant M, Caterson RJ, Waugh DA, et al. Protein intake in renal disease. J Am Soc Nephrol. 1997 May;8(5):777-83. https://doi: 10.1681/ASN.V85777.
Padkins M, Breen T, Anavekar N, Barsness G, Kashani K, Jentzer JC. Association Between Albumin Level and Mortality Among Cardiac Intensive Care Unit Patients. J Intensive Care Med. 2021 Dec;36(12):1475-1482. https://doi: 10.1177/0885066620963875.
de Rooij SE, Govers A, Korevaar JC, Abu-Hanna A, Levi M, de Jonge E. Short-term and long-term mortality in very elderly patients admitted to an intensive care unit. Intensive Care Med. 2006 Jul;32(7):1039-44. https://doi: 10.1007/s00134-006-0171-0.
Akirov A, Masri-Iraqi H, Atamna A, Shimon I. Low Albumin Levels Are Associated with Mortality Risk in Hospitalized Patients. Am J Med. 2017 Dec;130(12):1465.e11-1465.e19. https://doi: 10.1016/j.amjmed.2017.07.020.
Vincent JL, Russell JA, Jacob M, Martin G, Guidet B, Wernerman J, et al. Albumin administration in the acutely ill: what is new and where next? Crit Care. 2014 Jul 16;18(4):231. https://doi: 10.1186/cc13991.
Fulks M, Stout RL, Dolan VF. Albumin and all-cause mortality risk in insurance applicants. J Insur Med. 2010;42(1):11-7.
Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: Pathogenesis and Clinical Significance. JPEN J Parenter Enteral Nutr. 2019 Feb;43(2):181-193. https://doi: 10.1002/jpen.1451.
Oh J, Kim SH, Park KN, Oh SH, Kim YM, Kim HJ, Youn CS. High-sensitivity C-reactive protein/albumin ratio as a predictor of in-hospital mortality in older adults admitted to the emergency department. Clin Exp Emerg Med. 2017 Mar 30;4(1):19-24. https://doi: 10.15441/ceem.16.158.
Charles PG, Wolfe R, Whitby M, Fine MJ, Fuller AJ, Stirling R, et al. Australian Community-Acquired Pneumonia Study Collaboration; Grayson ML. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis. 2008 Aug 1;47(3):375-84. https://doi: 10.1086/589754.