Ischemia-modified albumin is a predictor of short-term mortality in patients with severe sepsis**

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Abstract

Purpose:

One of the most important events leading to morbidity and mortality in patients with severe sepsis is the development of global tissue hypoperfusion and oxidative damage. Ischemia-modified albumin (IMA), an albumin generated under ischemic and oxidative conditions, is a marker of oxidative stress and hypoperfusion. Here, we investigated whether IMA level could predict short-term mortality with severe sepsis.

Methods:

A prospective cohort study was conducted from April 2014 to October 2014 in intensive care units in a tertiary hospital. At the onset of severe sepsis, serum IMA level was measured, and baseline and laboratory data, infection sources, and underlying diseases were recorded; Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores were calculated. Multivariate logistic regression and receiver operating characteristic curve analyses were used to evaluate predictors of mortality. Kaplan-Meier analysis was used to compare survival at day 28.

Results:

A total of 117 patients with severe sepsis were included (overall 28-day mortality, 24.8%). The IMA level was higher in nonsurvivors than in survivors (P < .05). It was a strong predictor of 28-day mortality (area under the receiver operating characteristic curve, 0.742; P < .001), and the optimal cutoff for IMA level maximizing sensitivity and specificity was 110 U/mL. On multivariate logistic regression, Acute Physiology and Chronic Health Evaluation II score and IMA level were independent risk factors for death. Survival rate was reduced with very high IMA level (≥110 U/mL; P < .05).

Conclusions:

The IMA level, especially at least 110 U/mL, may be a useful predictor of death for patients with severe sepsis.

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