Association of Low Serum Albumin Levels and its In-hospital Adverse Outcomes among Patients Presenting with Acute Coronary Syndrome in a Tertiary Care Hospital of West Bengal, India
Published: May 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/60490.17825
Bichitra Biswas, Kuntolika Mani, Ranajit Bari, Sandip Ghosh, Chanchal Kumar Jana
1. Specialist Medical Officer, Department of General Medicine, Basirhat District Hospital, Basirhat, West Bengal, India.
2. Assistant Professor, Department of Physiology, IPGME&R, Kolkata, West Bengal, India.
3. Assistant Professor, Department of General Medicine, Tamralipto Government Medical College, Tamluk, West Bengal, India.
4. Associate Professor, Department of General Medicine, IPGME&R, Kolkata, West Bengal, India.
5. Retired Professor and Head, Department of General Medicine, R.G. Kar Medical College, Kolkata, West Bengal, India.
Correspondence
Ranajit Bari,
Flat No. 203, B Block, Mayfair Venus II, 354, S.N Ghosh Avenue, Narendrapur, Kolkata-700103, West Bengal, India.
E-mail: dr.ranajit@gmail.com
Introduction: Acute Coronary Syndrome (ACS) is characterised by hypercoagulability and inflammation. In the acute presentation of Ischaemic Heart Disease (IHD), such as ACS, serum albumin may also play an important role. Many patients with an ischaemic cerebrovascular accident, a condition similar to ACS, had low serum albumin levels.
Aim: To estimate serum albumin levels in patients with ACS and their relation to hospital adverse outcomes.
Materials and Methods: The present prospective observational study was conducted in the Department of General Medicine at R.G. Kar Medical College and Hospital, West Bengal, India. The duration of the study was 18 months, from July 2019 to October 2020. Patients with ACS were included irrespective of age, sex, race, and predisposing factors such as Hypertension (HTN), Diabetes Mellitus (DM), hyperthyroidism, and dyslipidaemia. A total of 125 patients were included, and details such as relevant history, examination findings, laboratory investigation, Electrocardiography (ECG), Echocardiography (ECHO), chest X-ray Posteroanterior (PA) view were included. Chi-square test and logistic regression were applied.
Results: A total of 94 (75.2%) patients were male. 49 (39.2%) study patients had DM. A total of 10 (8%) patients presented with cardiac arrest at admission. In-hospital death occurred in 9 (7.2%) cases. 59 (47.2%) patients had a normal serum albumin level (3.5-4.5). 61 (48.8%) had mild to moderate hypoalbuminaemia (2.5-3.5), and only 5 (4%) had severe hypoalbuminaemia (<2.5). The association of in-hospital complications vs serum albumin level was statistically significant (p<0.0001). A multivariate logistic regression analysis showed that male gender (p-value=0.026), smoking (p-value=0.008), arrhythmia (p-value=0.002), increased creatinine (p-value=0.032), and hypoalbuminaemia (p<0.001) were statistically significant independent predictors of in-hospital adverse outcomes.
Conclusion: The low serum albumin level, measured immediately on hospital admission in ACS patients, was associated with in-hospital complications, and when adjusted for other covariates, hypoalbuminaemia predicts in-hospital adverse outcomes independently.
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