Correlation of Post-Operative Hypoalbuminemia with Outcome of Pediatric Cardiac Surgery

Abstract

Background: Hypoalbuminemia may be caused by liver disease, nephrotic syndrome, burns, protein-losing entropathy, malnutrition, and metabolic stress. Alterations in albumin in metabolic stress such as cardiac surgery have been previously investigated. We studied serum albumin concentration in children with congenital heart disease and also the association of hypoalbuminemia with mortality and morbidity after pediatric cardiac surgery.

Methods: We measured serum albumin concentration prospectively in 300 children with congenital heart disease who underwent surgery between July and September 2008 in Shaheed Rajaee hospital. Serum albumin concentration was measured before and 48 hours after cardiac surgery and was subsequently compared between 2 groups: cyanotic and acyanotic and also with normal values.

Results: Serum albumin concentration decreased on the second post-operative day in 70 (23.3%) patients. There was a positive correlation between the post-surgical hypoalbuminemia and cyanotic heart disease. The cyanotic children had lower serum albumin concentration than the acyanotic ones (P value <0.001). There was a significant association between post-operative serum albumin concentration and acute renal failure (P value <0.001) and death (P value <0.001). Drop in serum albumin concentration was more prominent in the males than in the females (P value=0.038) and in the cyanotic patients than in the acyanotic ones (P value <0.001) as well as in those with acute renal failure (P value <0.001), pericardial effusion (P value =0.050), seizure (P value <0.001), and death (P value <0.001). Hypoalbuminemia was not associated with longer hospital (P value=0.142) or intensive care unit stay (P value=0.199 ).

Conclusion: Post-operative serum albumin concentration was lower in the cyanotic children and male patients in our study. In addition, the post-operative decrease in albumin was associated with an increased risk of pericardial effusion, renal failure, seizure, and death.