Aygül ELATAŞ, Selvi GÜLAŞI, Mustafa Kurthan MERT, Eren KALE ÇEKİNMEZ, Orkun TOLUNAY

Preterm morbiditeleri ve mortalitesinin tahmininde serum albümini ile laktat düzeyinin karşılaştırılması

Amaç: 32 haftadan küçük preterm bebeklerde neonatal morbiditeleri ve mortaliteyi öngörmede serum albumin ve laktat düzeylerini karşılaştırmayı amaçladık. Gereç ve Yöntem: Bebeklerin tıbbi kayıtları retrospektif olarak incelendi. Hastalar üç gruba ayrıldı; plazma albümin düzeyi ≤ 2.5 g/dL olanlar Grup 1, 2.6-3 g/dL olanlar Grup 2 ve ≥ 3 g/dL olanlar Grup 3 olarak tanımlandı. < 28 gebelik haftası olan bebekler alt grup olarak analiz edildi. Bulgular: Ortalama gebelik yaşı 28.7 ± 2.4 hafta ve ortalama doğum ağırlığı 1240 ± 405 gram olan 300 bebek dahil edildi. Mortaliteyi öngörmede; ilk üç gün içindeki albümin düzeyi duyarlılığı %74.4 ve özgüllüğü %73.2 (cut-off < 2.9 g/dL), en düşük albümin seviyesinin duyarlılığı %90.7 ve özgüllüğü %70.1 (cut-off < 2.65 g/dL), laktat seviyesinin duyarlılığı %67.4 ve özgüllüğü %63.3 (cut-off > 3.1 mmol/L) idi. < 28 hafta bebeklerin analizinde; en düşük albümin seviyesinin duyarlılığı %80 ve özgüllüğü %66.7 (cut-off < 2.45 g/dL), ilk üç gün içindeki albümin seviyesinin duyarlılığı %74.3 ve özgüllüğü %72.6 (cut-off < 2.8 g/dL), laktatın duyarlılığı %74.3 ve özgüllüğü %64.2 (cut-off > 3.1 mmol/L) idi. Sonuç: Düşük serum albumin düzeyi mortaliteyi öngörmede laktata göre daha özgül ve duyarlı görünmektedir ve mortalite tahmin skorlarına eklenmesi düşünülebilir.

Anahtar Kelimeler:

: Hipoalbüminemi, morbidite, mortalite, preterm, yenidoğan

Comparison of serum albumin level and lactate for predicting preterm morbidities and mortality

Purpose: We aimed to comparison of serum albumin and lactate level for predicting neonatal morbidities and mortality in preterm infants < 32 weeks of gestation. Materials and Methods: The medical records of babies were retrospectively analyzed. Patients were divided into three groups; plasma albumin levels ≤ 2.5 g/dL were defined as Group 1, 2.6-3 g/dL as Group 2 and ≥ 3 g/dL as Group 3. The babies < 28 weeks of gestation were analysed as a subgroup. Results: 300 infants with mean gestational age of 28.7 ± 2.4 weeks and mean birth weights 1240 ± 405 grams were included. In predicting mortality; the sensitivity of the albumin level within the first three days was 74.4% and the specificity was 73.2% (cut-off < 2.9 g/dL), the sensitivity of the lowest albumin level was 90.7% and the specificity was 70.1% (cut-off < 2.65 g/dL), the sensitivity of the lactate level was 67.4% and the specificity was 63.3% (cut off > 3.1 mmol/L). Analysis of < 28 weeks babies; the sensitivity of lowest albumin level was 80% and the specifity was 66.7% (cut-off < 2.45 g/dL) and the sensitivity of the albumin level within the first three days was 74.3% and the specificity was 72.6% (cut-off < 2.8 g/dL), and the sensitivity of lactate was 74.3% and the specifity was 64.2% (cut-off > 3.1mmol/L). Conclusion: Low serum albumin level appears to be more specific and sensitive than lactate in predicting mortality and may be considered to be added to mortality prediction scores.

Keywords:

Hypoalbuminemia, morbidity, mortality, preterm, newborn,

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Reading RF, Ellis R, Fleetwood A. Plasma albumin and total protein in babies from birth to eight weeks. Early Hum Dev. 1990;22:81-7.
Margarson MP, Soni N. Serum albumin: touchstone or totem? Anaesthesia. 1998;53:789-803.
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;237:319-34.
Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991;100:1619-36.
Yang C, Liu Z, Tian M, Xu P, Li B, Yang Q et al. Relationship between serum albumin levels and infections in newborn late preterm infants. Med Sci Monit. 2016;22:92-8.
Torer B, Hanta D, Yapakci E, Gokmen Z, Parlakgumus A, Gulcan H et al. Association of serum albumin level and mortality in premature infants. J Clin Lab Anal. 2016;30:867-72.
Rodríguez-Balderrama I, Ostia-Garza PJ, Villarreal-Parra RD, Tijerina-Guajardo M. Risk factors and the relation of lactic acid to neonatal mortality in the first week of life. Medicina Universitaria. 2016;18:3-9.
Vincent JL, Quintairos E Silva A, Couto L Jr, Taccone FS. The value of blood lactate kinetics in critically ill patients: a systematic review. Crit Care. 2016;13:20:257.
Hussain F, Gilshenan K, Gray PH. Does lactate level in the first 12 hours of life predict mortality in extremely premature infants? J Paediatr Child Health. 2009;45:263-7.
Watchko JF, Spitzer AR, Clark RH. Prevalence of hypoalbuminemia and elevated bilirubin/albumin ratios in a large cohort of infants in the neonatal intensive care unit. J Pediatr. 2017;188:280–6.
Ying Q, You XQ, Luo F, Wang JM. Maternal-neonatal serum albumin level and neonatal respiratory distress syndrome in late-preterm infants. Front Pediatr. 2021;9:666934.
Bunt JE, Rietveld T, Schierbeek H, Wattimena JL, Zimmermann LJ, van Goudoever JB. Albumin synthesis in preterm infants on the first day of life studied with [1-13C] leucine. Am J Physiol Liver Physiol. 2007;292:1157-61.
Abdelaal MA, Donia A, Elsayeh AAK, Al shorbagy MS. Correlation between serum albumin levels and neonatal sepsis in preterm infants. Al-Azhar J Pediatr. 2019;22:1-20.
Akram NN, Hussein SA, Abdullah WH. Significance of measuring serum albumin in preterm neonates during 1st day of life. Curr Pediatr Res. 2021;25:1082-88.
El-Lahony DM, El-Sayed HM, Mostafa HM. Evaluation of serum albumin level among preterm septicemic newborn infants. Menoufia Med J. 2018;31:1018-22.
Park JH, Chang YS, Ahn SY, Sung SI, Park WS. Predicting mortality in extremely low birth weight infants: Comparison between gestational age, birth weight, Apgar score, CRIB II score, initial and lowest serum albumin levels. PLoS One. 2018;13:e0192232.
Morris I, McCallion N, El-Khuffash A, Molloy EJ. Serum albumin and mortality in very low birth weight infants. Arch Dis Child Fetal Neonatal Ed. 2008;93:310-2.
Mohd Amin AT, Zaki RA, Friedmacher F, Sharif SP. C reactive protein/albumin ratio is a prognostic indicator for predicting surgical intervention and mortality in neonates with necrotizing enterocolitis. Ped Surg Int. 2021;37:881–6.
Tuten A, Dincer E, Topcuoglu S, Sancak S, Akar S, Hakyemez Toptan H et al. Serum lactate levels and perfusion index: are these prognostic factors on mortality and morbidity in very low-birth weight infants? J Matern Fetal Neonatal Med. 2017;30:1092-5