On-treatment serum albumin levels can predict 28-day mortality and guide albumin infusion in sepsis patients

Danfeng Ren Tianzhi Ni Xiangyun Dang Jingwen Zhou Ze Zhang Shan Fu Taotao Yan Yingren Zhao Jinfeng Liu ^*

• Department of Infectious Diseases, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China

Background: As the most abundant protein in plasma, albumin (ALB) presents close association with prognosis of septic patients. Whereas, the benefit and the target level of ALB infusion remain controversial.We conducted a retrospective investigation to assess whether on-treatment ALB levels could predict 28-day mortality and try to identify the optimal level for ALB infusion. All patients diagnosed as sepsis from January 2016 to December 2020 were recruited and re-evaluated using Sepsis-3 criteria.Results: A total of 199 eligible patients were enrolled in this study. Compared with the survival group, the non-survival group had more males (73.97 vs. 56.35%), older patients (62.78±15.93 vs. 56.43±18.46), and a higher proportion of Gram-positive bacterial infection (27.40 vs 23.02%), higher Sequential Organ Failure Assessment (SOFA) score (7.00-13.00 vs 6.00-12.00), higher APACHE II score (18.25-29.00 vs 15.00-26.00), higher ), more patients with septic shock (65.75%vs 43.65%), shorter ICU-stay days (11.04±6.28 vs. 14.83±8.58), longer mechanical ventilation days (7.23±7.07 vs. 5.04±8.52), with statistically significant differences (p<0.050). Furthermore, we identified that the ALB level on day 7 (HR, 0.920; 95% CI, 0.847 to 0.999; p = 0.046) and the maximum ALB level within the first 14 days (HR, 0.900; 95% CI, 0.838 to 0.967; p = 0.004) were independent protective factor for the 28-day prognosis in septic patients. Moreover, ROC curve analysis indicated that optimal target level for first 14-day maximum and on day 7 were 33.45g/L and 27.85g/L, respectively. Correspondingly, a negative correlation between ALB level and mortality was defined with Kaplan-Meier survival curve analysis. Further subgroup analysis showed that the group with ALB above the cut-off value was associated with favorable outcomes in female patients under 60 years, with SOFA score less than 7, and APACHE II score less than 19.ALB levels on day 7 and the maximum ALB level within first 14 days after ICU admission were closely associated with 28-day mortality. 27.85g/L would work as the target level of ALB infusion on 7 day to improve the prognosis of sepsis patients.