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Relationship between the albumin level and the anesthesia method and the effect on clinical course in patients with major burns.

BACKGROUND
Due to a massive increase in capillary permeability during the state of shock caused by burns, albumin and intravascular fluid rapidly move to the extravascular areas. Therefore, hypoalbuminemia is seen as an early and prolonged finding in major burns. Hypoalbuminemia leads to various problems. The aim of this study was to investigate the effect of the preoperative albumin level on perioperative morbidity and mortality in patients with major burns.


METHODS
Demographic data, preoperative albumin levels, surgical records, and clinical follow-up records of a total of 61 patients who underwent surgery for major burns in our hospital for the last 2 years were examined. Intraoperative complications were recorded, such as hypotension, bradycardia, low saturation, metabolic acidosis, reduced urine output, and hyperglycemia. Postoperative complications were recorded as intubation and the use of mechanical ventilator, sepsis, ARDS, acute renal failure, tracheotomy, hemorrhage, arrest, pneumonia, urinary tract infection, tissue infection, congestive heart failure, and pleural effusion.


RESULTS
In patients with albumin levels measured as <2 gr/dL and >2 gr/dL, intraoperative complications were determined at the rates of 31.4% and 20.8%, respectively, postoperative complications at 60.0% and 51.5%, respectively, and mortality rates at 40% and 25.8%, respectively (p=0.148, p=0.251, p=0.85, respectively). The cut-off point for the preoperative albumin level affecting postoperative morbidity was determined as ≥2.3 gr/dL (Area Under Curve=0.587; p<0.001; 95% Confidence Interval, 0.476-0.699; Cut-Off Albumin, ≥2.3).


CONCLUSION
There is as yet no consensus on the time and dosage of the delivery of albumin in patients with major burns. Although there are studies in the literature that have shown increased morbidity and mortality rates in individuals given albumin in the intensive care, there are also reports supporting the finding that it makes a positive contribution. No useful guidelines have been obtained on the subject of hypoalbuminemia in patients with major burns. The results of this study showed that the albumin level above or below 2 gr/dL did not create any change in perioperative morbidity and mortality; however, the preoperative level above 2.3 gr/dL was the cut-off value for morbidity.