Serum albumin and clinical outcome in pediatric cardiac surgery

Objective: We evaluated the behavior of serum albumin concentrations in response to metabolic stress that is associated with cardiac surgery and the role of this protein as a predictor of clinical outcome in children at high surgical risk who undergo operative correction of congenital heart defects. Methods: Serum albumin concentrations were measured in 30 children who had heart disease and were at high surgical risk. Analyses were performed before surgery, on the second postoperative day, and on discharge from the intensive care unit. Preoperative serum concentrations of albumin were compared with those of a control group that consisted of 20 healthy and well-nourished children. Results: Preoperative albumin concentrations of patients were lower than those of the control group (3.4 0.25 g/dL versus 4.0 0.18 g/dL, P < 0.05). Serum levels decreased on the second postoperative day and at discharge from the intensive care unit (3.1 0.65 g/dL and 3.2 0.44 g/dL, P < 0.05) compared with preoperative concentrations. Preoperative concentrations lower than 3.0 g/dL were associated with increased postsurgical infection (P = 0.0026) and with increased mortality (P = 0.0138). Patients whose postoperative levels were lower than 3.0 g/dL had longer hospital stays compared with those whose concentrations were higher than 3.0 g/dL (14.5 1.3 d versus 10 2.2 d, P < 0.05). Conclusion: The results suggest that hypoalbuminemia is common among children who have heart disease and are at high surgical risk, and serum albumin concentrations lower than 3 g/dL may be related to outcome in the period after cardiac surgery. 2005 Elsevier Inc. All rights reserved.