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Abstract

Introduction. Hypoalbuminemia is a strong predictor of mortality in nonoperative and operative patients. Albumin plays a role in maintaining oncotic pressure in critical conditions such as sepsis. The administration of exogenous Human Serum Albumin (HSA) in sepsis with hypoalbuminemia conditions is still controversial with varying outcomes.This study aimed to know the mortality ratio between intravenous albumin administration and no intravenous albumin administration in sepsis patients with hypoalbuminemia conditions and also to know the factors that influence the mortality of sepsis patients. Methods. An observational study with a prospective approach involving 75 research subjects aged >18 years with sepsis accompanied by hypoalbuminemia (<2.5 g/dL) treated in the high care unit of RSUD dr. Saiful Anwar Malang during the period 1 September 2018-31 August 2019. Subjects were divided into two groups namely albumin and nonalbumin groups. Both groups were followed during hospitalization until they discharged or died. Differences in mortality between the two groups were analyzed by chi square bivariate test. The most influential factors on mortality were analyzed by multivariate binary logistic regression tests. Results. There were 39 people (52%) from the albumin group and 36 people (48%) from the non-albumin group. Difference in mortality between albumin and nonalbumin groups {25 (64.1%) vs 16 (44.4%) with OR 2, p=0.138} means there was no statistically significant difference. Factors that influence mortality included: SOFA score (OR 34.27, p <0.001), MAP value (OR 8, p<0.001), septic shock (OR 4.31, p=0.03), diabetes mellitus (OR 0.28, p=0.009), respiratory failure (OR 8.02, p <0.001), decreased of consciousness (OR 64.75, p <0.001), cardiovascular failure (OR 6, p <0.001), hematological failure (OR 3.05, p=0.027). The most dominant factor affecting mortality in sepsis patients is decreased of consciousness (OR 2.67, p=0.001). Conclusion. The administration of albumin transfusion did not make a significant difference in the incidence of mortality in sepsis patients with hypoalbuminemia. The most influential factor on mortality of sepsis patients is decreased of consciousness.

Bahasa Abstract

Pendahuluan. Hipoalbuminemia merupakan prediktor kuat terhadap mortalitas pada pasien non operatif maupun operatif. Albumin berperan mempertahankan tekanan onkotik pada kondisi kritis seperti sepsis. Pemberian human serum albumin (HSA) eksogen pada sepsis dengan kondisi hipoalbuminemia masih kontroversial dengan hasil luaran yang bervariasi. Penelitian ini dilakukan untuk mengetahui perbandingan mortalitas antara pasien sepsis dengan kondisi hipoalbuminemia yang diberikan albumin intravena dan tanpa pemberian albumin intravena serta mengetahui faktor yang berpengaruh terhadap mortalitas pasien sepsis. Metode. Penelitian observasional dengan pendekatan prospektif melibatkan 75 subjek penelitian usia >18 tahun dengan sepsis disertai hipoalbuminemia (<2,5 g/dL) yang dirawat di ruangan high care unit RSUD dr. Saiful Anwar Malang selama periode 1 September 2018-31 Agustus 2019 yang terbagi menjadi dua kelompok, yaitu kelompok albumin dan nonalbumin. Kedua kelompok diikuti selama hospitalisasi sampai pulang atau meninggal dunia. Perbedaan mortalitas antara kedua kelompok dianalisis dengan uji bivariat chi square. Faktor yang paling berpengaruh terhadap mortalitas dianalisis dengan uji multivariat regresi logistik berganda. Hasil. Didapatkan 39 orang (52%) dari kelompok albumin dan 36 orang (48%) dari kelompok non albumin. Perbedaan jumlah mortalitas antara kelompok albumin dan nonalbumin {25 (64,1%) vs. 16 (44,4%) yang mana perbedaan tersebut tidak bermakna secara statistik dengan nilai OR 2 (p=0,138}. Faktor yang berpengaruh terhadap mortalitas antara lain: skor SOFA (OR 34,27, p<0,001), nilai MAP (OR 8, p<0,001), kondisi syok septik (OR 4,31, p=0,03), diabetes melitus (OR 0,28, p=0,009), kondisi gagal nafas (OR 8,02, p<0,001), penurunan kesadaran (OR 64,75, p<0,001), gagal kardiovaskular (OR 6, p<0,001), dan kondisi gagal hematologi (OR 3,05, p=0,027). Faktor yang paling dominan berpengaruh terhadap mortalitas pasien sepsis adalah penurunan kesadaran (OR 2,67, p=0,001). Simpulan. Pemberian transfusi albumin tidak memberikan perbedaan bermakna terhadap kejadian mortalitas pada pasien sepsis dengan kondisi hipoalbuminemia. Faktor yang paling berpengaruh terhadap mortalitas pasien sepsis adalah kondisi penurunan kesadaran.

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