The association between hypoalbuminemia and microcirculation, endothelium and glycocalyx disorders in children with sepsis.

Abstract Background Endothelial inflammation and activation in sepsis can alter albumin synthesis and increase its loss. In these patients, hypoalbuminemia tends to be associated with worse outcomes. The consequences of hypoalbuminemia for the microcirculation of children with sepsis are unknown. We evaluated the association between hypoalbuminemia and microcirculation disorders, endothelial activation and glycocalyx degradation in this group of patients. Methods This was an observational, analytical, prospective cohort study in children with sepsis hospitalized in the pediatric intensive care unit (PICU). The primary outcome was the association between hypoalbuminemia and microcirculation disorders using a perfused boundary region (PBR) > 2.0 µm on sublingual video microscopy or plasma biomarkers (syndecan-1, angiopoietin-2). The secondary outcomes were the association between hypoalbuminemia, microcirculation disorders, the inflammatory response and the need for mechanical ventilation. Results Out of the 1,180 admissions to the PICU during the study period, 125 patients with sepsis were included. The median age was 2.0 years (IQR 0.5–12.5), and the main focus of infection was respiratory. Children with hypoalbuminemia had more abnormal microcirculation with a higher PBR flow corrected (2.16 µm [IQR 2.03–2.47] vs. 1.92 [1.76–2.28]; p = 0.01) and more 4–6 µm capillaries recruited (60% vs. 40%; p = 0.04). The low albumin group that had the worst PBR had the most 4–6 µm capillaries recruited (rho 0.29; p < 0.01), 48% higher Ang-2 (p = 0.04), worse annexin A5 (p = 0.03) and no syndecan-1 abnormalities (p = 0.21). Children with hypoalbuminemia and a greater percentage of blood volume in their capillaries needed mechanical ventilation more often (56.3% vs. 43.7%; aOR 2.01 95% CI 1.38–3.10 :p < 0.01). Children with corrected hypoalbuminemia had improved PBR levels (aOR: 0.17: p5% CI 0.04–0.75; p = 0.02), shorter PICU stays (p = 0.01) and lower mortality (p = 0.02). Conclusions In children with sepsis, an association was found between hypoalbuminemia and microcirculation changes, vascular permeability and greater endothelial glycocalyx degradation. Hypoalbuminemia correction was associated with a recovered glycocalyx, shorter hospital stay and lower mortality.