European Journal of Cardiovascular Medicine

Serum albumin, the most abundant plasma protein, performs multiple homeostatic functions including maintenance of oncotic pressure, transport of endogenous and exogenous compounds, antioxidant activity and modulation of inflammatory responses. Low serum albumin (hypoalbuminemia) frequently develops early in the course of critical illness as a result of systemic inflammation, capillary leak, redistribution and altered hepatic synthesis, and it therefore represents an integrated marker of both nutritional and disease severity [1].

Prognostic importance of albumin in intensive care populations has been repeatedly reported. Large database analyses and single-center cohorts have shown a stepwise increase in mortality as admission albumin declines, and admission hypoalbuminemia has been independently associated with higher in-hospital and 28-day mortality after adjustment for conventional severity scores [2,3]. Beyond a single baseline measurement, several investigators have emphasized the additional value of serial albumin kinetics: progressive decline or failure of albumin to recover during the early hospital course has been correlated with worse outcomes, prolonged organ support and failure to wean from mechanical ventilation [4,5].

Despite this accumulating evidence, much of the available literature comprises retrospective analyses or heterogeneous patient populations, and prospective observational data from medical intensive care settings—especially from resource-limited tertiary hospitals—remain comparatively sparse. Furthermore, the relationship between admission albumin categories, subsequent temporal albumin trajectories and specific morbidity indicators such as requirement for mechanical ventilation has not been uniformly quantified across studies [6].

Accordingly, the present prospective, hospital-based observational study enrolled 100 critically ill patients admitted to the MICU and ICCU to evaluate whether admission serum albumin and its serial measurements over the first 10 days of hospitalization are associated with survival and key morbidity outcomes (mechanical ventilation and duration of hospital stay). By analysing both admission categories and longitudinal albumin trends, we aimed to clarify the prognostic utility of albumin monitoring in a tertiary care medical ICU population

Study Design: This investigation was structured as a hospital-based, observational, prospective study conducted within the Department of Medicine at GMERS Medical College and General Hospital, Gotri, Vadodara. The study was carried out over a two-year period beginning from the date of institutional approval. All procedures were undertaken in accordance with institutional guidelines, and ethical clearance was obtained from both the Scientific Research Committee and the Institutional Human Ethics Committee prior to participant recruitment.

Study Site and Study Population: The study population comprised critically ill patients admitted to the Medical Intensive Care Unit (MICU) and the Intensive Cardiac Care Unit (ICCU) of GMERS General Hospital, Gotri. Eligible individuals were screened consecutively, and those fulfilling the predetermined criteria were enrolled using a purposive sampling approach. A total of 100 patients meeting the eligibility requirements formed the final study cohort.

Eligibility Criteria: Patients were included if they were critically ill due to an underlying medical condition and if written informed consent was provided by the patient or a legally authorized representative. Individuals were excluded if they had comorbidities known to influence serum albumin levels, including chronic liver disease, chronic kidney disease, protein-losing enteropathy, or clinically evident malnutrition. Pregnant patients and those who did not provide consent were also excluded.

Data Collection and Clinical Assessment: After obtaining consent, a detailed history and comprehensive clinical examination were performed at admission. Laboratory investigations relevant to the study objectives were undertaken as part of the routine diagnostic work-up of the hospital. Serial serum albumin measurements were obtained for all enrolled subjects. Albumin concentrations were assessed at predefined time points—Day 0, Day 1, Day 3, Day 5, Day 7, and Day 10. Patients were subsequently categorized into survivor and non-survivor groups for comparison. In addition to mortality, indicators of morbidity, including need for mechanical ventilation and total duration of hospitalization, were documented and evaluated in relation to the albumin profile.

Outcome Measures: The primary endpoint was survival status during hospitalization. Secondary outcomes included requirement for ventilatory support and length of hospital stay. Serial albumin trends were examined to assess their association with these clinical outcomes.

Statistical Analysis: Data were recorded using a standardized, pre-validated case record form and entered into Microsoft Excel for organization and preliminary processing. Statistical analyses were performed using SPSS version 22. Descriptive statistics, including mean, median, and standard deviation, were applied to summarize quantitative variables. Comparisons between continuous variables were conducted using the Student’s t-test, while categorical variables were analyzed using the Chi-square test. A p-value below 0.05 was interpreted as evidence of statistical significance.

The study population comprised 100 individuals, of whom 27 did not survive and 73 recovered. Demographic features, including sex distribution and age categories, demonstrated no statistically meaningful association with survival outcomes (Table 1). Both males and females were proportionately represented in the survivor and non-survivor groups, and the age strata did not reveal any differential survival pattern, as indicated by non-significant p-values.

Serum albumin concentrations at admission showed a clear association with mortality (Table 2). Individuals presenting with lower albumin values constituted a disproportionately larger share of the non-survivor group, and this relationship reached statistical significance.

Serial albumin measurements during the clinical course exhibited consistently lower values among non-survivors at each assessed time point (Table 3). The divergence between the two groups persisted throughout follow-up, with highly significant differences observed from baseline through Day 10.

A similar pattern emerged when the need for ventilatory support was considered (Table 4). Patients with reduced albumin levels on admission were more likely to require mechanical ventilation, and the association was statistically significant..

Table 1: Comparison between Demographic Parameters and Survival

Table 2: Serum Albumin Levels on Admission

Table 3: Follow-up Duration

Table 4: Comparison Between Albumin Level on Admission and Need of Mechanical Ventilation

In this prospective cohort of critically ill medical patients, admission hypoalbuminemia and persistently low serum albumin during the first 10 days of hospitalization were strongly associated with adverse clinical outcomes. Patients presenting with albumin <3.5 g/dL were overrepresented among non-survivors (Table 2) and showed a sustained decline in serial measurements compared with survivors (Table 3). These observations align with prior evidence linking lower baseline albumin to higher risk of respiratory complications and death in critically ill adults, supporting the notion that hypoalbuminemia is more than a nutritional marker and reflects the severity of the acute pathophysiological response [7].

The temporal separation of albumin trajectories between survivors and non-survivors in our cohort (Table 3) corroborates studies that have highlighted the incremental prognostic value of serial albumin monitoring over a single admission measurement. Failure of albumin to recover, or progressive decline during the early hospital course, has been associated with prolonged organ support and increased mortality in several observational series, suggesting that dynamic albumin behaviour captures ongoing inflammation, capillary leakage and impaired synthetic reserve that static values may miss [8,9].

Our finding that low admission albumin was associated with higher likelihood of requiring mechanical ventilation (Table 4) is consistent with mechanistic and clinical data linking hypoalbuminemia to pulmonary edema and respiratory dysfunction. Low plasma oncotic pressure and albumin-mediated antioxidant/anti-inflammatory functions may contribute to alveolar-capillary barrier vulnerability and worse pulmonary outcomes, which in turn increase the need for ventilatory support in susceptible patients [7]. Clinically, several prognostic models for ventilator dependence incorporate markers related to physiologic reserve and systemic illness burden; our results suggest albumin could be considered among such predictors in medical ICU populations [10].

The lack of a significant association between demographic factors (age strata and sex) and survival in our sample (Table 1) indicates that the prognostic signal from albumin was not simply a surrogate for basic demographic risk. This finding echoes earlier unselected cohort analyses where admission hypoalbuminemia predicted worse outcomes across age and sex subgroups, reinforcing albumin’s role as an integrative biomarker of physiological stress rather than a demographic correlate alone [11].

From a practical standpoint, the robustness of the albumin–outcome relationship across heterogeneous critically ill cohorts has implications for bedside risk stratification. Several large secondary-database and single-center investigations have demonstrated dose–response relations between albumin levels and short-term mortality, and some reports suggest that combining albumin with established severity scores modestly improves prognostic discrimination [12]. Whether routine serial albumin measurement should be embedded in ICU prognostic workflows depends on reproducibility, incremental predictive value, and whether identification of hypoalbuminemia leads to actions that change outcomes.

Finally, although albumin replacement has been evaluated in various critical care settings, randomized evidence supporting routine albumin infusion to improve hard outcomes remains inconsistent; observational associations therefore do not imply that correcting albumin will alter prognosis without addressing the underlying inflammatory and capillary-leak processes [13,14]. Our results should therefore be interpreted as supporting the utility of albumin as a prognostic marker and a potential trigger for heightened monitoring and early consideration of organ-support needs, rather than as direct evidence for albumin-based therapeutic strategies.

Strengths of the present study include its prospective design and systematic serial sampling up to Day 10, while limitations include a single-center setting and a modest sample size that constrain causal inference and external generalizability. Future research should evaluate whether albumin-informed clinical pathways (for example, earlier respiratory support planning or targeted anti-inflammatory strategies) can translate the prognostic information into improved patient-level outcomes.

The present study demonstrates that serum albumin concentration at admission, as well as its trajectory during the early course of critical illness, has a strong association with clinical outcomes in hospitalized medical ICU patients. Lower albumin values were consistently linked with higher mortality risk and a greater likelihood of requiring mechanical ventilation. Furthermore, the persistent divergence in serial albumin trends between survivors and non-survivors underscores its potential value as a dynamic prognostic indicator. These findings suggest that early identification of hypoalbuminemia may aid in risk stratification and clinical decision-making in critically ill individuals.

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