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

Abstract

Introduction: The purpose of study is to investigate whether serum albumin concentration on hospital arrival may be associated with the long-term mortality in survivors from OHCA.

Methods: Retrospective analysis of patients who had presumed cardiac cause of arrest and achieved sustained return of spontaneous circulation (ROSC) from prospective OHCA registry was conducted. The individual medical records were reviewed for the data including initial serum albumin. Primary outcome was survival at 6 months. The secondary outcome was cerebral performance category (CPC) at 6 months. Differences of variables between survivors and non-survivors at 6 months after cardiac arrest were analyzed. Albumin was categorized into tertiles as <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 their 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: Of 547 OHCA patients, 136 patients had presumed cardiac cause of arrest and had sustained ROSC with available initial serum albumin. Survival rate at 6 months was significantly higher in patients with a higher albumin group and neurological outcomes were also more favorable in higher albumin group (log rank test, p <0.05). In a Cox proportional hazard regression analysis, initial serum lactate and albumin was independently associated with 6-month mortality and albumin showed moderate discriminative power for 6-month mortality by ROC analysis (AUC = 0.738, 95% CI 0.652-0.825).

Conclusions: Serum albumin might be associated with long-term mortality and neurological outcome in patients with presumed cardiac cause of arrest and sustained ROSC from OHCA.