Serum protein level in conjunction with serum albumin/globulin ratio as an indicator of severity of changes in capillary permeability

Kumar, Pramod; D’Souza, Jovial; Bhaskara, KG; Bharadwaj, Salil

doi:10.1016/s0305-4179(03)00149-9

Cited by 4 publications

(6 citation statements)

References 7 publications

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“…To address these discrepancies, some investigators have sought the prognostic value of different scales by simplifying them (13–17) or by increasing the difficulty of obtaining results with more complex calculations (18–20). Because the most important function of albumin is to maintain an oncotic pressure of at least 80% of the normal level, its reduction could induce complications that predispose patients to malnutrition, the loss of immune responses, and an increased risk of infection (21). Several studies have shown the deleterious effects of hypoalbuminemia in terms of hospital stay, morbidity, and mortality in patients with various conditions, including critically ill patients or those patients undergoing chronic renal replacement therapy and surgical patients (22–24).…”

Section: Discussionmentioning

confidence: 99%

“…These skin injuries induce a strong inflammatory response and the release of vasoactive substances, which increases the skin permeability to water, albumin, and even larger protein molecules (21,30–32). This process peaks during the first 12–24 hours, coupled with a reduction in the albumin mRNA response to the burn and an increased synthesis and accumulation of acute-phase reactants.…”

Section: Discussionmentioning

confidence: 99%

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Serum albumin level as a risk factor for mortality in burn patients

Aguayo-Becerra¹,

Torres-Garibay²,

Macías-Amezcua³

et al. 2013

Clinics

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OBJECTIVE:Hypoalbuminemia is a common clinical deficiency in burn patients and is associated with complications related to increased extravascular fluid, including edema, abnormal healing, and susceptibility to sepsis. Some prognostic scales do not include biochemical parameters, whereas others consider them together with comorbidities. The purpose of this study was to determine whether serum albumin can predict mortality in burn patients.METHODS:We studied burn patients ≥16 years of age who had complete clinical documentation, including the Abbreviated Burn Severity Index, serum albumin, globulin, and lipids. Sensitivity and specificity analyses were performed to determine the cut-off level of albumin that predicts mortality.RESULTS:In our analysis of 486 patients, we found that mortality was higher for burns caused by flame (p = 0.000), full-thickness burns (p = 0.004), inhalation injuries (p = 0.000), burns affecting >30% of the body surface area (p = 0.001), and burns associated with infection (p = 0.008). Protein and lipid levels were lower in the patients who died (p<0.05). Albumin levels showed the highest sensitivity and specificity (84% and 83%, respectively), and the area under the receiver-operating characteristic curve (0.869) had a cut-off of 1.95 g/dL for mortality.CONCLUSION:Patients with albumin levels <2 g/dL had a mortality risk of >80%, with 84% sensitivity and 83% specificity. At admission, the albumin level could be used as a sensitive and specific marker of burn severity and an indicator of mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Serum albumin level as a risk factor for mortality in burn patients

Aguayo-Becerra¹,

Torres-Garibay²,

Macías-Amezcua³

et al. 2013

Clinics

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“…For this reason, we excluded patients with cirrhosis from the study. In the presence of pathogenic microorganisms, endotoxins, cytokines, oxygen free radicals, and other related factors, the glycocalyx in the surface of vascular endothelial cells was exfoliated and the close junction between vascular endothelial cells was impaired, leading to increased vascular endothelial permeability [11,[23][24][25][26][27][28][29][30]. The imbalance between albumin leakage and recycling, together with the dysfunction of metabolism, finally causes hypoalbuminemia and the change of the osmotic pressure around the blood vessel.…”

Section: Discussionmentioning

confidence: 99%

Difference in hematocrit and plasma albumin levels as an additional biomarker in the diagnosis of infectious disease

Dai¹,

Wang²,

Hu³

et al. 2020

aoms

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Introduction: In clinical practice, it has been observed that patients with severe infections show changes to their hematocrit (HCT) and serum albumin (ALB) levels. This study aimed to evaluate whether the difference of HCT and ALB (HCT-ALB) levels can be used as an additional biomarker for fast diagnosis of severe infections. Material and methods: This was a retrospective case-control study which included adult patients with severe infections, patients with non-infective conditions and healthy individuals. A total of 7,117 individuals were recruited in Yunnan Province, China, from January 2012 to January 2018, and were divided into three groups: 1,033 patients with severe infections (group 1); 1,081 patients with non-infective conditions (group 2); and 5,003 healthy individuals from the general population (group 3). The potential diagnostic threshold of HCT-ALB for severe infectious patients was determined by the receiver operating characteristic (ROC) curve analysis. Group 3 was used as the reference to draw the ROC curves of the HCT-ALB value in group 1 or group 2. Results: HCT-ALB values in each group were significantly different. We found that the area under the ROC curve (AUC) of group 1 reached 0.87 (95% CI: 0.86-0.89), whereas the AUC of group 2 was 0.60 (95% CI: 0.58-0.62). To reach a higher specificity of 99.0% (95% CI: 98.8-99.3%, and with sensitivity of 37.5%, 95% CI: 34.5-40.5%), a HCT-ALB value of 10.25 was recommended as the standard for diagnosis of severe infection. Conclusions: The HCT-ALB value was increased in patients with infectious disease. The measurement of the HCT-ALB value (> 10.25) might be useful in the fast diagnosis of infectious disease.

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“…Hence, measurement of changes in their circulating level may help in grading the capillary pore size. 6 Thus, protein levels (depending on the capillary pore size) in group 1, 2, and 3 may help in assessing the severity of inflammation and grouping the patients based on that. Depending on the progression of the pathology or effect of treatment some patients showed shift from one group to other (group shifters).…”

Section: Discussionmentioning

confidence: 99%

“…As the albumin (69 kDa) molecule is smaller than globulin (90 -156 kDa), 5,6 it is evident that because of changes in capillary permeability, albumin will be lost from the circulation earlier and faster than globulin (Figs. 1, 2).…”

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confidence: 99%

Grading of Severity of the Condition in Burn Patients by Serum Protein and Albumin/Globulin Studies

Kumar¹

2010

Annals of Plastic Surgery

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Capillary permeability increases after inflammation with consequent leak of fluid, electrolytes, and proteins. The albumin molecule size being smaller (69 kDa) than the globulin molecule (90-156 kDa) will leak relatively at an early stage of the disease (with moderate increase in capillary pore size) than globulin leading to albumin/globulin reversal. In cases with severe permeability changes with rapid progression to larger pore size with simultaneous leak of both albumin and globulin, albumin/globulin reversal will not occur. In this study estimation the serum protein and albumin/globulin (A/G) ratio at frequent intervals was done to grade the severity of the condition of burn patients by assessing the severity of capillary leak.A total of 61 admitted patients (from March 2002 to December 2004) based on the protein values were divided into 3 groups (group 1: 6-8 g/dL, group 2: 5.1-5.9 g/dL, group 3: < or =5.0 g/dL), and all the patients who showed change in their protein levels during the study were shifted to appropriate group and were classified as group shifters. The mean survival time and mortality of various groups were compared, and A/G ratio of all the expired cases was analyzed.Group 3 patients showed higher mortality (95%) as compared to that in other groups (group 1 and 2: 0% each and group shifters: 30.2%). Median survival time of group 3 was significantly low as compared to that of group 1 (P < 0.0026), group 2 (P < 0.0006), and group shifters (P < 0.0000). In group shifters the mean time (days) required for shifting from one group to other just before death or discharge in survivors was significantly higher than that in expired cases. Of 26 cases expired during the study, initial A/G ratio at the time of first assigning the group was not reversed in 22 cases (84.6%).The study concluded that the severity (indicated by lower serum protein values) and speed (judged by A/G ratio changes and median survival time analysis) of capillary permeability changes were associated with high mortality, and therefore, it is possible to grade the severity of the condition in burn patients.

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Serum protein level in conjunction with serum albumin/globulin ratio as an indicator of severity of changes in capillary permeability

Cited by 4 publications

References 7 publications

Serum albumin level as a risk factor for mortality in burn patients

Serum albumin level as a risk factor for mortality in burn patients

Difference in hematocrit and plasma albumin levels as an additional biomarker in the diagnosis of infectious disease

Grading of Severity of the Condition in Burn Patients by Serum Protein and Albumin/Globulin Studies

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