Clinical Significance of Serum Prealbumin (Transthyretin) Level of Nutritional Assessment Index in Massive Burn Patients

Yoon, Jae Chul; Yim, Hae Jun; Cho, Yong Suk; Ko, Jang Hyu; Lee, Boung Chul; Seo, Cheong Hoon; Kim, Dohern; Hur, Jun; Chun, Wook; Kim, Jong Hyun

Abstract

PURPOSE: Hangang Sacred Heart Hospital Burn Center has operated the Nutritional Support Team (as known as NST) since 2003. From our experiences of active participation of NST, our authors believed the serum prealbumin level of Nutritional Assessment Index can be a useful testing index for assessing burn patients clinical condition. Therefore, we would like to verify the correlation of the prealbumin level with the patients prognosis.
METHODS
The subjects are limited to those who has made at least a single visit to NST during their hospital stay from January 1, 2005 to December 31, 2008 at Hangang Sacred Heart Hospital Burn Center. The total number of NST patients were 129 patients in 2005, 124 patients in 2006, 131 patients in 2007, and 127 patients in 2008. It includes those patients who deceased due to the burn shock within a few days of first admission. Basically it includes any patients regardless of chance of survival rate who has seen the NST at least once during the study period. We obtained the lowest serum prealbumin level of NST patients from 2005 to 2008 and made comparison analysis within the subjects.
RESULTS
The mortality rate of NST patients decreased in the study period from 2005 to 2008 as time passed by (47%-37%-24%-22%). However, the lowest serum prealbumin level of mean value was increased notably. The mean values of lowest prealbumin level were 6.07 in 2005, 6.73 in 2006, 9.53 in 2007 and 7.31 in 2008. The mean total body surface burned areas were 50.3% in 2005, 44.6% in 2006, 43.1% in 2007 and 47.2% in 2008. The lowest prealbumin level in the survived group is 2 to 3 gm/dl higher than the deceased group. The lowest prealbumin level in deceased group was shown mostly below 7 mg/dl and mortality rate was extremely increased to 35% to the group below 5 mg/dl.
CONCLUSION
Our study suggests it is necessary to pay special attention if prealbumin level drops below 7 mg/dl in massive burn patients. If the level drops below 5 mg/dl or 6 mg/dl, it can be considered as nutritional condition of the patient is poor and need to make extra observations on several criteria such as nutritional supply, high in catabolism and progression of septicemia to assess proper needed care for burn patients.