U-shaped association between serum albumin and pediatric intensive care unit mortality in critically ill children

Xuepeng Zhang; Lifan Zhang; Canzheng Wei; Liwei Feng; Juqin Yang; Geng Zhang; Guoyan Lu; Xiying Gui; Yue Zhou; Kaiying Yang; Jiangyuan Zhou; Xinle Zhou; Ruoran Wang; Siyuan Chen; Yi Ji

doi:10.3389/fnut.2022.931599

U-shaped association between serum albumin and pediatric intensive care unit mortality in critically ill children

Front Nutr. 2022 Aug 30:9:931599. doi: 10.3389/fnut.2022.931599. eCollection 2022.

Authors

Xuepeng Zhang^{1

2

3}, Lifan Zhang⁴, Canzheng Wei^{2

5}, Liwei Feng¹, Juqin Yang⁶, Geng Zhang², Guoyan Lu⁷, Xiying Gui⁸, Yue Zhou², Kaiying Yang¹, Jiangyuan Zhou¹, Xinle Zhou⁹, Ruoran Wang², Siyuan Chen², Yi Ji¹

Affiliations

¹ Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China.
² Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China.
³ Department of Critical Care Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China.
⁴ West China School of Medicine, Sichuan University, Chengdu, China.
⁵ Department of Critical Care Medicine, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China.
⁶ Biobank, West China Hospital, Sichuan University, Chengdu, China.
⁷ Department of Pediatric Critical Care Medicine, West China Women's and Children's Hospital, Sichuan University, Chengdu, China.
⁸ Department of Critical Care Medicine, People's Hospital of Tibet Autonomous Region, Lhasa, China.
⁹ Department of Pediatric Critical Care Medicine, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, China.

Abstract

Introduction: The detailed association between albumin levels and mortality has not been studied in critically ill children. The aim of this study was to reveal an association between albumin levels in detail and mortality in critically ill children.

Materials and methods: We retrospectively collected data from children admitted to four pediatric intensive care units (PICUs) in China between January 2015 and October 2020. Restricted cubic spline curves based on logistic regression models were generated to evaluate the detailed associations between serum albumin levels and PICU mortality. Threshold effect analysis was performed using two piecewise regression models.

Results: The study included 9,123 children. The overall mortality was 5.3%. The detailed association between serum albumin levels and the risk of mortality followed a U-shape. The risk of mortality decreased with increasing serum albumin levels (OR = 0.919; 95% CI: 0.886, 0.954) in children with serum albumin levels < 43.2 g/L and increased with increasing serum albumin levels (OR = 1.174; 95% CI: 1.044, 1.316) in children with serum albumin levels ≥ 43.2 g/L.

Conclusion: There was a U-shaped association between serum albumin levels and mortality in critically ill children in the PICU.

Keywords: albumin; children; critical care; mortality; restricted cubic spline.