As known, it is often difficult to differentiate septic shock from other types of shock. According to researchers at Robert Packer Hospital in Sayre, Pennsylvania, low serum albumin at admission is a marker that helps establish the type of shock. Early identification using serum albumin thus may improve outcomes. The study was presented at CHEST 2011, the 77th annual meeting of the American College of Chest Physicians, in Honolulu.
The investigators conducted a retrospective analysis of data extracted using International Classification of diseases ICD-9 codes -- 785.52 for septic shock, 785.51 for cardiogenic shock, and 785.59 for shock not elsewhere specified (NES) without mention of trauma (w/t). All the patients were admitted to the intensive care unit from the emergency room with documented serum albumin on admission; further, all had prior serum albumin >/=3gm/dl.
The total number of patients with a diagnosis of shock was 603 and 99 patients were included. Those with septic shock numbered 49, cardiogenic shock 26, and shock NES w/t 24. The median value of serum albumin on admission for septic shock, shock w/t NES and cardiogenic shock was 2.7, 2.8, and 3.5 gm/dl, respectively. The median serum albumin on admission was lower for septic shock when compared to cardiogenic shock. (P <0.001) There also was a statistically significant difference in admission albumin between cardiogenic and shock w/t NES (P <0.001).There was no statistical significant difference in mean serum albumin on admission between septic shock and shock w/t NES (P >0.05). The researchers determined that serum albumin of </=3gm/dl on admission has a sensitivity of 68% (95%, confidence interval [CI], 0.51 to 0.78) and specificity of 92% (95% CI, 0.75 to 0.97) to differentiate cardiogenic shock from all other types of shock.
As noted, low serum albumin on admission can serve as a diagnostic marker to differentiate septic shock from cardiogenic shock but not from shock NES w/t. High serum albumin of >3 gm/dl on admission can be used as a marker to differentiate cardiogenic shock from any other types of shock.