Hypoalbuminemia and its Relation with Acute Respiratory Distress Syndrome and In-Hospital Mortality in Intensive Care Unit patients
Keywords:
Hypoalbuminemia, Respiratory distress syndrome, Hospital mortalityAbstract
Objective: To evaluate the association of hypoalbuminemia with acute respiratory distress syndrome (ARDS), in-hospital mortality and length of hospital stay in intensive care unit (ICU) patients and to determine the relation of ARDS with demographics and worst clinical outcomes.
Methodology: This cross-sectional study was done at the Federal Government Polyclinic Hospital, Islamabad after ethical approval. The study duration was 8 months from March 2024 to October 2024. After taking informed consent from patients or their attendants, 350 patients admitted to the medical ICU were included using non-probability convenience sampling technique. The demographic details of the patients, their co-morbidities and primary diagnoses were noted. The serum samples of the patients were sent to the laboratory for estimation of serum albumin levels. Patients were allocated to group I having serum albumin <3.5 mg/dl (n=210) and Group II with serum albumin levels >3.5 mg/dl (n=140). The outcomes assessed were the frequency of ARDS, length of ICU stay, and in-hospital mortality. The statistical analysis was done by the Statistical Package for the Social Sciences (SPSS) version 25.
Results: Out of 350 patients, 136(38.9%) developed ARDS; 34.3% had low albumin levels whereas, only 4.6% had normal serum albumin. In-hospital mortality occurred in 30% of the patients, out of which 20.3% and 9.7% of the patients had low and normal serum albumin, respectively. The mean length of ICU stay was 12.2±1.4 days and 8.9±2.5 days in group I and group II, respectively. These findings were statistically significant. Acute respiratory distress syndrome has a significant association with age, risk factors, serum albumin levels, length of ICU stay, and in-hospital mortality.
Conclusion: Acute respiratory distress syndrome, in-hospital mortality, and length of hospital stay have a significant relation with hypoalbuminemia in ICU patients. There was a significant association of acute respiratory distress syndrome with advanced age, risk factors, in-hospital mortality, and length of hospital stay.
References
1. Gremese E, Bruno D, Varriano V, Perniola S, Petricca L, Ferraccioli G. Serum albumin levels: a biomarker to be repurposed in different disease settings in clinical practice. J Clin Med. 2023; 12(18):6017. doi:10.3390/jcm12186017.
2. Violi F, Novella A, Pignatelli P, Castellani V, Tettamanti M, Mannucci PM, et al. Low serum albumin is associated with mortality and arterial and venous ischemic events in acutely ill medical patients. Results of a retrospective observational study. Thromb Res. 2023; 225:1-10. doi:10.1016/j.thromres.2023.02.013.
3. Karunarathna I, Athulgama P, Dius S, Ranwala R, Bandara S, Godage S, et al. From diagnosis to management: hypoalbuminemia unveiled. 2024; 1-8. doi:10.13140/RG.2.2.12492.94087.
4. Thongprayoon C, Cheungpasitporn W, Chewcharat A, Mao MA, Thirunavukkarasu S, Kashani KB. Risk of acute respiratory failure among hospitalized patients with various admission serum albumin levels: a cohort study. Medicine (Baltimore). 2020; 99(9):e19352. doi:10.1097/MD.0000000000019352.
5. Mendes RS, Pelosi P, Schultz MJ, Rocco PRM, Silva PL. Fluids in ARDS: more pros than cons. Intensive Care Med Exp. 2020; 8(Suppl 1):32. doi:10.1186/s40635-020-00319-x.
6. Gao J, Yang X, Fang X, Zhang Z, Wang D, Wang J. Clinical significance of lactate-to-albumin ratio in patients with influenza A virus-induced acute respiratory distress syndrome: a single-center retrospective study. BMC Anesthesiol. 2024; 24(1):459. doi:10.1186/s12871-024-02843-9.
7. Bardaji-Carrillo M, Lopez-Herrero R, Aguilar G, Arroyo-Hernantes I, Gomez-Sanchez E, Camporota L, et al. Epidemiological trends of mechanically ventilated acute respiratory distress syndrome in the twenty-first century: a nationwide, population-based retrospective study. J Intensive Care. 2025; 13(1):9. doi:10.1186/s40560-025-00781-3.
8. Yingchoncharoen P, Thongpiya J, Saowapa S, Abdelnabi M, Vinan-Vega M, Nugent K. Severe acute respiratory distress syndrome secondary to concomitant influenza A and rhinovirus infection complicated by methicillin-resistant Staphylococcus aureus Pneumonia in an early pregnancy patient with vaping-induced lung injury. J Community Hosp Intern Med Perspect. 2023; 13(4):91-6. doi:10.55729/2000-9666.1213.
9. Ma W, Tang S, Yao P, Zhou T, Niu Q, Liu P, et al. Advances in acute respiratory distress syndrome: focusing on heterogeneity, pathophysiology, and therapeutic strategies. Signal Transduct Target Ther. 2025; 10(1):75. doi:10.1038/s41392-025-02127-9.
10. Gowa MA, Tauseef U, Ahmed SH. A relation between serum albumin level and prognosis of critically ill children admitted to the pediatric intensive care unit. J Pak Med Assoc. 2023; 73(5):1034-42. doi:10.47391/JPMA.7465.
11. McNeil JB, Jackson KE, Wang C, Siew ED, Vincz AJ, Shaver CM, et al. Linear association between hypoalbuminemia and increased risk of acute respiratory distress syndrome in critically ill adults. Crit Care Explor. 2021; 3(9):e0527. doi:10.1097/CCE.0000000000000527.
12. Matthay MA, Thompson BT, Ware LB. The Berlin definition of acute respiratory distress syndrome: should patients receiving high-flow nasal oxygen be included? Lancet Respir Med. 2021; 9(8):933-6. doi:10.1016/S2213-2600(21)00105-3.
13. Saner FH, Stueben BO, Hoyer DP, Broering DC, Bezinover D. Use or misuse of albumin in critical ill patients. Diseases. 2023; 11(2):68. doi:10.3390/diseases11020068.
14. Kumar M, Jain K, Chauhan R, Meena SC, Luthra A, Thakur H, et al. Hypoalbuminemia: incidence and its impact on acute respiratory distress syndrome and 28-day outcome in trauma patients. Eur J Trauma Emerg Surg. 2023; 49(5):2305-14. doi:10.1007/s00068-023-02318-5.
15. Zhang L, Deng T, Zeng G, Chen X, Wu D. The association of serum albumin with 28-day mortality in critically ill patients undergoing dialysis: a secondary analysis based on the eICU collaborative research database. Eur J Med Res. 2024; 29(1):530. doi:10.1186/s40001-024-02127-5.
16. Ozgungor Y, Yeniay H, Rollas K. Albumin levels as prognostic markers in ICU mortality. J Coll Physicians Surg Pak. 2025; 35(1):30-3. doi:10.29271/jcpsp.2025. 01.30.
17. Maemum S, Mariana N, Wijaya SO, Oktavia D, Lisdawati V, Rogayah R. Is hypoalbuminemia a predictor marker of mortality? Health Sci J Indones. 2020; 11(2):121-5. doi:10.22435/hsji.v11i2.3072.
18. Wang HX, Huang XH, Ma LQ, Yang ZJ, Wang HL, Xu B, et al. Association between lactate-to-albumin ratio and short-time mortality in patients with acute respiratory distress syndrome. J Clin Anesth. 2024; 99:111632. doi:10.1016/j.jclinane.2024.111632.
19. Wang X, Zhang T, Gao X, Cai H, Guo M, Liu Q, et al. Early human albumin administration is associated with reduced mortality in septic shock patients with acute respiratory distress syndrome: a retrospective study from the MIMIC-III database. Front Physiol. 2023; 14:1142329. doi:10.3389/fphys.2023.1142329.
20. Brown R, McKelvey MC, Ryan S, Creane S, Linden D, Kidney JC, et al. The impact of aging in acute respiratory distress syndrome: a clinical and mechanistic overview. Front Med (Lausanne). 2020; 7:589553. doi:10.3389/fmed.2020.589553.
21. Yin R, Yang X, Yao Y. Risk factors for acute respiratory distress syndrome in sepsis patients: a meta-analysis. Heliyon. 2024; 10(18):e37336. doi:10.1016/j.heliyon.2024.e37336.
22. Wang DH, Jia HM, Zheng X, Xi XM, Zheng Y, Li WX. Attributable mortality of ARDS among critically ill patients with sepsis: a multicenter, retrospective cohort study. BMC Pulm Med. 2024 4; 24(1):110. doi:10.1186/s12890-024-02913-1.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Journal of Sharif Medical & Dental College is licensed and distributed under the terms of Creative Commons Attribution-NonCommercial 4.0 International License.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
