Prognostic Significance of Initial Serum Albumin on Mortality in Out-of-hospital Cardiac Arrest

Park, Inwon; Lee, Jae Hyuk; Kim, Kyuseok; Jo, You Hwan; Kim, Joonghee; Kim, Taeyun; Kim, Yu Jin; Lee, Jin Hee; Rhee, Joong Eui

Abstract

PURPOSE
The association of serum albumin concentration on hospital arrival with long-term mortality in survivors from out-of-hospital cardiac arrest (OHCA) was investigated.
METHODS
A retrospective analysis was conducted of patients presumed to have cardiac cause of arrest and achieved sustained return of spontaneous circulation (ROSC) from prospective OHCA. The individual medical records were reviewed for data, including initial serum albumin. The primary outcome was survival at 6 months and the secondary outcome was Cerebral Performance Category (CPC) at 6 months. Differences in variables between survivors and non-survivors at 6 months after cardiac arrest were analyzed. Albumin was categorized into tertiles of <2.9 g/dL, 2.9 to 3.7 g/dL, and >3.7 g/dL. Hazard ratios (HRs) were estimated using Cox-proportional hazard models in both univariate and multivariate analysis. All prognostic variables with p value<0.1 in univariate analysis were used in multivariate analysis for adjustment. Receiver operating curve (ROC) analysis was performed to evaluate the discriminative power of albumin.
RESULTS
In a total of 547 OHCA patients, 136 patients had a presumed cardiac cause of arrest and sustained ROSC with available initial serum albumin. The survival rate at 6 months was significantly higher in patients in the higher albumin group and neurological outcomes were also more favorable in the higher albumin group (log rank test, p<0.05). In a Cox proportional hazard regression analysis, initial serum lactate and albumin levels were independently associated with 6-month mortality and albumin levels showed moderate discriminative power for 6-month mortality by ROC analysis (AUC=0.738, 95% CI: 0.652-0.825).
CONCLUSION
Serum albumin is associated with long-term mortality and neurological outcome in patients with presumed cardiac cause of arrest and sustained ROSC from OHCA.