Hostname: page-component-848d4c4894-ndmmz Total loading time: 0 Render date: 2024-05-30T08:11:23.163Z Has data issue: false hasContentIssue false

Perioperative serum albumin and its influence on clinical outcomes in neonates and infants undergoing cardiac surgery with cardiopulmonary bypass: a multi-centre retrospective study

Published online by Cambridge University Press:  04 June 2019

Brandon M. Henry
Division of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Santiago Borasino
Section of Cardiac Critical Care Medicine, Division of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, AL, USA
Laura Ortmann
Division of Critical Care, Department of Pediatrics, Children’s Hospital and Medical Center, Omaha, NE, USA
Mayte Figueroa
Division of Cardiology and Critical Care, Department of Pediatrics, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO, USA
A.K.M. Fazlur Rahman
Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
Kristal M. Hock
Section of Cardiac Critical Care Medicine, Division of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, AL, USA
Mario Briceno-Medina
Department of Pediatric Cardiology, Le Bonheur Children’s Hospital and University of Tennessee Health Science Center, Memphis, TN, USA
Jeffrey A. Alten*
Division of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
Author for correspondence: Jeffrey A. Alten, MD, Division of Cardiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA. Tel: +1-513-803-5448; E-mail:


Hypoalbuminemia is associated with morbidity and mortality in critically ill children. In this multi-centre retrospective study, we aimed to determine normative values of serum albumin in neonates and infants with congenital heart disease, evaluate perioperative changes in albumin levels, and determine if low serum albumin influences post-operative outcomes. Consecutive eligible neonates and infants who underwent cardiac surgery with cardiopulmonary bypass at one of three medical centres, January 2012–August 2013, were included. Data on serum albumin levels from five data points (pre-operative, 0–24, 24–48, 48–72, 72 hours post-operative) were collected. Median pre-operative serum albumin level was 2.5 g/dl (IQR, 2.1–2.8) in neonates versus 4 g/dl (IQR, 3.5–4.4) in infants. Hypoalbuminemia was defined as <25th percentile of these values. A total of 203 patients (126 neonates, 77 infants) were included in the study. Post-operative hypoalbuminemia developed in 12% of neonates and 20% of infants; 97% occurred in the first 48 hours. In multivariable analysis, perioperative hypoalbuminemia was not independently associated with any post-operative morbidity. However, when analysed as a continuous variable, lower serum albumin levels were associated with increased post-operative morbidity. Pre-operative low serum albumin level was independently associated with increased odds of post-operative hypoalbuminemia (OR, 3.67; 95% CI, 1.01–13.29) and prolonged length of hospital stay (RR, 1.40; 95% CI, 1.08–1.82). Lower 0–24-hour post-operative serum albumin level was independently associated with an increased duration of mechanical ventilation (RR, 1.35; 95% CI, 1.12–1.64). Future studies should further assess hypoalbuminemia in this population, with emphasis on evaluating clinically meaningful cut-offs and possibly the use of serum albumin levels in perioperative risk stratification models.

Original Article
© Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Gatta, A, Verardo, A, Bolognesi, M. Hypoalbuminemia. Intern Emerg Med 2012; 7: 193199.CrossRefGoogle ScholarPubMed
Karas, PL, Goh, SL, Dhital, K. Is low serum albumin associated with postoperative complications in patients undergoing cardiac surgery?. Interact Cardiovasc Thorac Surg 2015; 21: ivv247.CrossRefGoogle ScholarPubMed
Kittisakmontri, K, Reungrongrat, S, Lao-araya, M. Hypoalbuminaemia at admission predicts the poor outcomes in critically ill children.Anestezjol Intens Ter 2016; 48: 158161.CrossRefGoogle ScholarPubMed
Leite, HP, Rodrigues da Silva, AV, de Oliveira Iglesias, SB, Koch Nogueira, PC. Serum albumin is an independent predictor of clinical outcomes in critically ill children. Pediatr Crit Care Med 2016; 17: e50e57.CrossRefGoogle ScholarPubMed
Castleberry, C, White-Williams, C, Naftel, D, et al. Hypoalbuminemia and poor growth predict worse outcomes in pediatric heart transplant recipients. Pediatr Transplant 2014; 18: 280287.CrossRefGoogle ScholarPubMed
Kapoor, P, Narula, J, Chowdhury, U, Kiran, U, Taneja, S. Serum albumin perturbations in cyanotics after cardiac surgery: patterns and predictions. Ann Card Anaesth 2016; 19: 300.CrossRefGoogle ScholarPubMed
Leite, HP, Fisberg, M, de Carvalho, WB, de Camargo Carvalho, AC. Serum albumin and clinical outcome in pediatric cardiac surgery. Nutrition 2005; 21: 553558.CrossRefGoogle ScholarPubMed
O’Brien, SM, Clarke, DR, Jacobs, JP, et al. An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg 2009; 138: 11391153.CrossRefGoogle ScholarPubMed
Durward, A, Mayer, A, Skellett, S, et al. Hypoalbuminaemia in critically ill children: incidence, prognosis, and influence on the anion gap. Arch Dis Child 2003; 88: 419422.CrossRefGoogle ScholarPubMed
Tiwari, LK, Singhi, S, Jayashree, M, Baranwal, AK, Bansal, A. Hypoalbuminemia in critically sick children. Indian J Crit Care Med 2014; 18: 565569.Google ScholarPubMed
Cartlidge, PH, Rutter, N. Serum albumin concentrations and oedema in the newborn. Arch Dis Child 1986; 61: 657660.CrossRefGoogle ScholarPubMed
Horowitz, IN, Tai, K. Hypoalbuminemia in Critically Ill Children. Arch Pediatr Adolesc Med 2007; 161: 1048.CrossRefGoogle ScholarPubMed
Koertzen, M, Punjabi, P, Lockwood, G. Pre-operative serum albumin concentration as a predictor of mortality and morbidity following cardiac surgery. Perfusion 2013; 28: 390394.CrossRefGoogle ScholarPubMed
Figge, J, Rossing, TH, Fencl, V. The role of serum proteins in acid-base equilibria. J Lab Clin Med 1991; 117(6): 453467.Google ScholarPubMed
Sitges-Serra, A. Introduction to the symposium on hypoalbuminaemia. Clin Nutr 2001; 20: 263264.CrossRefGoogle Scholar
Vincent, J-L. Relevance of albumin in modern critical care medicine. Best Pract Res Clin Anaesthesiol 2009; 23(2): 183191.CrossRefGoogle ScholarPubMed
Kamada, T, McMillan, DE, Sternlieb, JJ, Björk, VO, Otsuji, S. Albumin prevents erythrocyte crenation in patients undergoing extracorporeal circulation. Scand J Thorac Cardiovasc Surg 1988; 22(2): 155158.CrossRefGoogle ScholarPubMed
Radman, M, Mack, R, Barnoya, J, et al. The effect of preoperative nutritional status on postoperative outcomes in children undergoing surgery for congenital heart defects in San Francisco (UCSF) and Guatemala City (UNICAR). J Thorac Cardiovasc Surg 2014; 147: 442450.CrossRefGoogle Scholar
Meites, S, Buffone, G. Pediatric Clinical Chemistry, 3rd edn. AACC Press, Washington, DC; 1989.Google Scholar
Sampaio, TZAL, O’Hearn, K, Reddy, D, Menon, K. The influence of fluid overload on the length of mechanical ventilation in pediatric congenital heart surgery. Pediatr Cardiol 2015; 36: 16921699.CrossRefGoogle ScholarPubMed
Ootaki, Y, Yamaguchi, M, Oshima, Y, Yoshimura, N, Oka, S. Effects of modified ultrafiltration on coagulation factors in pediatric cardiac surgery. Surg Today 2002; 32: 203206.CrossRefGoogle ScholarPubMed
Supplementary material: File

Henry et al. supplementary material

Table S1

Download Henry et al. supplementary material(File)
File 15.6 KB
Supplementary material: File

Henry et al. supplementary material

Table S2

Download Henry et al. supplementary material(File)
File 18.4 KB