Hypoalbuminemia predicts intensive care need among adult inpatients with community acquired pneumonia: a cross sectional study

Abstract

Introduction: Various scales helped physicians to decide the site of care of pneumonia patients, but had certain limitations. Literature review suggested that serum albumin and B/A ratio predict the site of care but more evidences were required. Therefore, the study was aimed to evaluate the role of serum albumin and B/A ratio in the prediction of intensive care need among patients with community acquired pneumonia.

Methodology: The cross-sectional analytical study enrolled 134 adult inpatients with pneumonia from Sir Ganga Ram Hospital, Lahore, Pakistan during September 2014 to December 2016. Serum albumin, creatinine and urea levels were estimated; and BUN, B/A ratio and CURB-65 scores were calculated to predict the need of ICU.

Results: Overall mean age was 50 ± 21 years, and 54.5% patients were females. The patients (19.4%) who required treatment in ICU had significantly lower albumin levels (p = 0.001); elevated BUN levels (p = 0.003), B/A ratio (p = 0.001) and CURB-65 score (p = 0.038); and longer hospital stay (p = 0.002). Hypoalbuminemia showed significant association with the requirement of ICU (OR: 7.956; p = 0.001). The optimal cut-off point of serum albumin to predict ICU need was 3.4 g/dL (50% sensitivity; 89% specificity). Low serum albumin was revealed as a good predictor of requiring treatment in ICU (AUC 0.718).

Conclusions: Hypoalbuminemia was a good predictor of requiring ICU treatment. Elevated B/A ratio and BUN levels showed significant association with ICU need. Serum albumin estimation before hospitalization might be used independently or additional with established criteria to decide the site of care.