DYNAMIC CHANGES IN ALBUMIN AND FIBRINOGEN LEVELS DURING SEPSIS: A PROSPECTIVE OBSERVATIONAL COHORT ANALYSIS.
DOI:
https://doi.org/10.51168/sjhrafrica.v6i6.1707Keywords:
Sepsis, albumin, fibrinogen, hepatic protein synthesis, stable isotope tracer, acute-phase responseAbstract
Background
Sepsis is a major cause of morbidity and mortality in critically ill patients, especially in low- and middle-income countries like India. Albumin and fibrinogen are key plasma proteins with opposing kinetic responses during inflammation and may serve as useful biomarkers in sepsis. This study aims to evaluate the kinetics of albumin and fibrinogen in septic patients to better understand their correlation with disease severity and outcomes.
Methods
This prospective, observational, comparative study was conducted at RIMS, Ranchi, over 12 months. Fifty-five patients (37 septic, 18 non-septic) were enrolled. Hepatic protein synthesis was assessed using stable isotope-labeled L-[ring-²H₅] phenylalanine infusion, followed by GC-MS analysis to determine FSR and ASR of albumin and fibrinogen.
Results
Septic patients had significantly lower plasma albumin and higher fibrinogen levels (p < 0.001). Albumin FSR was elevated (p = 0.03) without a significant change in ASR (p = 0.42), while both FSR and ASR of fibrinogen were significantly increased (p = 0.01, <0.001). The albumin/fibrinogen ASR ratio was markedly reduced (p < 0.001), indicating a shift toward acute-phase protein production in sepsis.
Conclusion
Sepsis is associated with hypoalbuminemia despite increased synthesis, likely due to elevated clearance. Hepatic protein synthesis shifts toward fibrinogen, reflecting a prioritized acute-phase response.
Recommendation
Future research with larger, multi-center cohorts is recommended to validate these findings and further investigate the biochemical differences between septic and non-septic patients. Exploring hepatic protein synthesis parameters may also offer valuable insights for clinical applications in sepsis management.
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