This study aims to assess the reliability of measurement of mass change in serum albumin compared to serum lactic acid as predictive tool for sepsis prognosis in nonsurgical ICU patients

This study explores the prognostic value of mass change in serum albumin compared to serum lactic acid levels in non-surgical ICU patients with sepsis. While serum lactate is an established marker of tissue hypo-perfusion and a predictor of sepsis outcomes, serum albumin is less frequently used for dynamic monitoring, although it is known to correlate with severity and mortality

Measurements:

Data Collection:

A-Baseline Data on ICU Admission:

1. Demographics: age, sex

2. Comorbidities (e.g., diabetes, hypertension, chronic kidney disease)

3. Initial hemodynamic parameters (BP-HR-SO2-ECG-UOP-TEMP-RR)

4. diagnosis of sepsis involves recognising signs of infection plus organ dysfunction according to SSC and sepsis -3

   A- Search about source of infection by:

   • History of present illness about main complain.
   • clinical examination
   • investigation a. labs (CBC (containing TLC and platlets), CRP, Procal, BloodGases (containing serum lactate), Urea, serum Creatinine, TotaL bilirubin, Urine Analysis, Pan culture, AST, ALT) b-imaging (chest x.ray) B- organ dysfunction Defined as increase increase in SOFA (Sequential Organ Failure Assessment) score >=2 points from baseline.

   SOFA Score range:

   0-6: low risk of organ failure 7-12: moderate risk >12: high risk of mortality

5. initial reading of serum albumin in admission (T0)

6. initial reading of albumin creat ratio (ACR)as tool for measuring albumin in urine Patients with severe albuminuria will be excluded from the study

Daily measurements:

1. Average of 24 HR (BP, HR, SO2, TEMP, RR,)
2. CBC, CRP, serum urea, serum creatinine, Total bilirubin, serum Albumin, blood gases (containing serum lactate)

3-24HR Fluid balance.

• ACR will be measured every 3days during study to predict any abnormal increase in albumin loss in urine

C- Daily recordings:

1. SOFA score.
2. mass changes in serum albumin (T0-T1, T1-T2, T3-T2……...ETC).
3. serum lactate.
4. vasopressor use.

Inclusion Criteria:

• Adults aged ≥18 year 70 years. Diagnosis of sepsis according to survival sepsis campaign(SSC). Patients admitted for medical (non-surgical) conditions.

Exclusion Criteria:

• Chronic liver disease or cirrhosis. Hyperalbuminuria (ex: nephrotic syndrome, nephritic syndrome). Terminal illness with an expected survival of less than 24 hours. Refusal or inability to obtain informed consent from patients or their care givers.

A prospective cohort study is planned, aiming to enroll a minimum of 40 patients. The sample size calculation is based on findings from Mahashabde et al. (2024), which reported that the predictive accuracy of serum lactase for septic shock at admission had an AUC ROC of 0.96, while serum albumin had an AUC ROC of 0.323. The anticipated incidence of septic shock is 42%, as reported in the EPIC ill study (2019). The sample size was calculated to achieve 100% statistical power with a significance level (alpha) of 0.05.