Hypoproteinemia predicts acute respiratory distress syndrome development, weight gain, and death in patients with sepsis : Critical Care Medicine

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Hypoproteinemia predicts acute respiratory distress syndrome development, weight gain, and death in patients with sepsis

Mangialardi, Robert J. MD; Martin, Greg S. MD; Bernard, Gordon R. MD; Wheeler, Arthur P. MD; Christman, Brian W. MD; Dupont, William D. PhD; Higgins, Stanley B. PhD; Swindell, Bridget B. RN for the Ibuprofen in Sepsis Study Group

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Critical Care Medicine 28(9):p 3137-3145, September 2000.

Abstract

Objective 

Starling’s equation indicates that reduced oncotic pressure gradients will favor edema formation, and the current consensus definition of acute respiratory distress syndrome (ARDS) excludes only the hydrostatic pressure contribution. We hypothesized that low serum total protein levels might correlate with the likelihood of ARDS in at-risk patients because serum total protein is the chief determinant of oncotic pressure in humans.

Design 

Regression analysis to compare outcomes in patients with low serum total protein levels with outcomes in patients with normal serum total protein levels with respect to weight change, development of ARDS, and mortality.

Setting 

Intensive care units (ICUs) of seven clinical centers in North America.

Patients 

A total of 455 ICU patients who met consensus criteria for severe sepsis (178 of whom developed ARDS) from a recently completed prospective clinical trial.

Intervention 

None.

Measurements and Main Results 

We found that 92% of the patients developing ARDS had low or borderline serum total protein levels (<6 g/dL). Logistic and multiple regression analyses confirmed that of 18 clinical variables, initial serum total protein level and protein change over time were the most statistically significant predictors of weight gain, prolonged mechanical ventilation, ARDS development, and mortality in the study population. This correlation remained significant after adjustment for the other major predictors of outcome present at baseline (ie, Acute Physiology and Chronic Health Evaluation II score).

Conclusions 

Hypoproteinemia is significantly correlated with fluid retention and weight gain, development of ARDS and poor respiratory outcome, and mortality in patients with sepsis. Prospective, randomized trials of serum protein manipulation are needed to establish whether there is a cause-effect relationship to this association.

Copyright © by 2000 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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