SERUM ALBUMIN AS A PREDICTOR OF SEVERITY, MORBIDITY, AND MORTALITY IN NEONATAL SEPSIS

Abstract

Objective: To evaluate early serum albumin levels as a predictor of disease severity, morbidity, and mortality among neonates with sepsis.

Study design: Prospective cohort study.

Place and duration of study: Neonatal Intensive Care Unit, Civil Hospital Karachi, over a six-month period.

Materials and methods: A total of 218 neonates with culture-confirmed sepsis were enrolled using consecutive sampling. Neonates with prior antibiotic exposure, hypoxic-ischemic encephalopathy, suspected inborn errors of metabolism, or prior blood transfusion were excluded. Serum albumin levels were measured at admission. Demographic, clinical, and laboratory data were recorded, and neonates were followed until discharge or death. Outcomes included morbidity, length of hospital stay, and mortality. Correlation analyses and multivariable regression models were applied.

Results: The mean gestational age was 35.1±2.9 weeks, and 55.5% were preterm. Hypoalbuminemia (<2.5 g/dL) was present in 42.2% of neonates. Overall mortality was 17.4%, and morbidity occurred in 37.2%. Mortality was significantly higher in neonates with hypoalbuminemia compared to those with normal serum albumin (30.4% vs. 7.9%, p <0.001), as was morbidity (56.5% vs. 23.0%, p <0.001). Neonates with hypoalbuminemia had a significantly longer hospital stay (12.6±5.1 vs. 7.8±3.2 days, p < 0.001). On multivariable analysis, hypoalbuminemia independently predicted mortality (AOR = 3.21) and morbidity (AOR = 2.87).

Conclusion: Early hypoalbuminemia is common in neonatal sepsis and independently predicts adverse outcomes. Serum albumin is a simple, cost-effective prognostic marker for early risk stratification.