Background and Aim Although hypoalbuminemia has been recognized as a marker of poor outcome in adult patients, this association has not been demonstrated in a general population of pediatric critically ill children, and studies have not considered non-nutritional factors that may influence albumin concentrations. This study aimed to determine whether hypoalbuminemia is associated with mortality and morbidity of critically ill children while considering the clinical severity of the patients.

Methods This was a prospective study involving 178 children admitted to the ICU. The outcome variables studied were ICU mortality, severity of organ dysfunction, free-ventilator days and free-ICU days. The outcome variables were as follows: nutritional status, Pediatric Index of Mortality (PIM 2), serum albumin, C Reactive Protein and lactate concentrations. Children with liver failure and chronic kidney disease were excluded.

Results Mean serum albumin concentration upon admission among survivors was 3.16+/–0.66 versus 2.63+/–0.67 in non-survivors (p=0.015). The mortality rate was 6.4% (11/178). In a multiple logistic regression model, adjusting for PIM 2 score, lower albumin concentrations were independently associated with increased organ dysfunction (OR: 0.18, 95% CI: 0.06–0.53; p=0.002) and mortality (OR: 0.22, 95% CI: 0.07–0.76; p=0.017). In a multiple linear regression model, adjusted for PIM2, malnutrition and other potential confounders, lower albumin concentrations were associated with fewer free-ventilator days (p=0.024) and free-ICU days (p=0.028).

Conclusions Children with hypoalbuminemia at admission are at a greater risk of organ dysfunction and mortality, and longer time of mechanical ventilation and length of ICU stay, independent of clinical severity and nutritional status.