(341) Relationship Between Serum Albumin and Delirium Duration and Severity in Critically Ill Adults

Sunday, January 21, 2024

11:00 AM – 12:00 PM MT

Location: Connections Central - RST 01

First Author(s)

RC

Rosalyn Chi, MD

Pulmonary and Critical care Fellow Physician
Indiana University, United States

Presenter(s)

Yara Khalifeh (she/her/hers)

Internal Medicine Resident
Indiana University Health
Indianapolis, Indiana

Co-Author(s)

Parth Savsani, MD, (he/him/his)

Indiana University School of Medicine
Samreen Jawaid, MD, (she/her/hers)

MD
Indiana University
SM

Salwa Moiz, n/a

Research Specialist
Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN, USA
Indianapolis, Indiana, United States
SG

Sujuan Gao, PhD

Professor of Biostatistics & Health Data Science
Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
Indianapolis, Indiana, United States
SW

Sophia Wang, MD.

Dr.
Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA., United States
SK

Sikandar Khan, DO, MS

Assistant Professor of Medicine/Physician Scientist
Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
Indianapolis, Indiana, United States
BK

Babar Khan, MD

Professor of Medicine/Physician Scientist
Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
Indianapolis, Indiana, United States

Introduction: While hypoalbuminemia has been associated with increased risk of intensive care unit (ICU) delirium, the relationship between serum albumin levels and the duration and severity of ICU delirium is not well defined. We hypothesized lower albumin levels would be associated with increased delirium duration and severity, and worse clinical outcomes (greater ICU lengths of stay (LOS) and mortality).

Methods: This secondary analysis utilized data from a randomized controlled trial involving adult ICU patients (≥ 18 years old) admitted to three academic hospitals between 2009 and 2015, who tested positive for delirium using the Confusion Assessment Method for the ICU (CAM-ICU) or the Richmond Agitation Sedation Scale (RASS). Delirium severity was assessed by CAM-ICU-7. Assessments were performed twice daily for up to 30 days. Delirium severity was computed as mean CAM-ICU-7 scores by day 8 or discharge. Delirum duration was defined as the number of days patients were free of delirium and not comatose. Serum albumin levels within 48 hours of ICU admission were collected from electronic medical records. Regression models were adjusted for age, sex, race, severity of illness, Chalson Comorbidity Index, and sepsis diagnosis.

Results: The study included 237 eligible patients with a mean age of 60 years: 53% were female, 60% required mechanical ventilation, 58% had respiratory failure or sepsis, and hospital mortality of 15%. Serum albumin levels were categorized as ≥3 g/dL (n=13), 2.5-2.99 g/dL (n=142), and < 2.5 g/dL(n=82). There were no significant associations between albumin levels and delirium duration (β=-0.04(SE 0.48), p=0.93)) or severity (β=0.24(SE 0.38), p=0.527)), or hospital mortality. Serum albumin levels of 2.5-2.99 g/dL were associated with shorter hospital LOS (β=-0.21, p=0.014), and a serum albumin ≥3 g/dL was associated with a shorter ICU LOS (β=-0.4, p=0.049).

Conclusions: Our study found low serum albumin levels were significantly associated with longer ICU and hospital LOS but not delirium duration or severity. Further research to elucidate mechanisms by which albumin is associated with delirium and clinical outcomes is needed.