Author(s): Gargadi S I*, Ramyil Seljul, Ogunjobi Allen A
Albumin is a single polypeptide chain of 585 amino acids and organized into 3 functional domains, stabilized by intrachain disulfide bonds. It is a major plasma protein and constitute 3/5th of total plasma protein by weight (3.4-4.7g/dL) which amounts to 25% of total protein synthesized in the liver.
Out of the 12g of albumin per day synthesized by the liver 40% is in body circulation and provides 75-80% of plasma osmotic pressure. It facilitates the transit of fatty acids, steroid, hormones, numerous ligands and drugs such as sulfonamides, penicillin G, dicumarol and aspirin [1].
The skin is the major site for extravascular albumin storage and is the major exchangeable albumin pool needed to maintain plasma levels. Hypoalbuminemia results from direct losses of albumin from tissue damage, from compromised hepatic blood flow due to volume loss, and from inhibitory tissue factors (e.g., Tumor necrosis factor, interleukin - 1, interleukin - 6) released at the burn sites [2].
Burns that exceeds 15% of Total body surface area (TBSA) usually manifest with systemic effects that persist till wound heals [3].
Patients with albumin levels < 2g/dL has a mortality risk of > 80% with 8.4% sensitivity and 83% specificity.
At admission, the albumin level could be used as a sensitive and specific marker of burn severity and an indicator of mortality [4].
In our study we correlated the relationship of levels of serum albumin in burn patients from admission to discharge with the length of hospital (morbidity) stay and mortality.
The information about the 73 patients and their Serum Albumin and total protein investigation results from admission to discharge or demise where provided by the hospital records and plastic surgery unit patient records from January 2016 - November, 2020.
We monitor the progress of our patients using regular serum albumin, comparing it with length of hospital stay in weeks, and mortality
Using the Cobas C III system we carried out the Albumin and total protein Colorimetric assay: At a PH value of 4.1, albumin displays a sufficiently cationic character to be able to bind with bromocresol green (BCG), an anionic dye, to form a blue-green complex. The color intensity of the blue-greencolor is directly proportional to the albumin concentration in the sample and is measured photo metrically in gram per deciliter.
We conducted serum Albumin and total protein assay of the 73 burn patients in our study among other investigations. We recorded 11 deaths, 7 where children and 4 where adults with various degree and types of burns. 92.2% of the patients had a hospital stay of 1-4 weeks while 7.8% of the patients had a hospital stay of 4.1 weeks to 77.8 weeks (illustrated in Fig.2 showing an inverse relationship of serum albumin and length of hospital stay).
Based on the serum Albumin at the time of death, those with albumin of < 25g/L have burn mortality sensitivity of 90.9% and specificity of 83.3%.
The length of hospital stay of the 62 burn patients that did not die are variable depending on type of burns, parts of the body affected and whether there is inhalational injury or first interventionist was a doctor or not.
58 patients were managed within 6 weeks before discharged while 4 patients stayed on admission for greater than 6 weeks. 2 out of the 4 patient that stay longest had high tension electric burn of 40% to 90% and the other 2 had flame burns of 14-26%.
We observed numerous factor that have provided prognosis for burn mortality such as presence of inhalational injury, burns in extremes of age (< 10 years or > than 50 years of age), extend and depth of burns, electric and chemical burns, presence of associated injuries such as fractures, spinal injury, splenic injury and presence of co-morbid factors such as diabetes mellitus and chronic renal failure among many factors. We find low serum level of albumin <25g/L at the time of death (with sensitivity of 90.9% and specificity of 83.3% of burn mortality) to be useful as a prognostic factor in burn mortality
Our study showed us that low level of serum albumin of <25g/L is a significant prognostic factor for burn mortality and has guided us to maintain serum albumin at optimum level to avert death in burn patients.
