Diagnostic and prognostic utility of prealbumin as a nutritional biomarker in critically ill children: a prospective cross sectional study

Abstract

Paediatric intensive care units (PICU) experience a big challenge with malnutrition. It significantly impacts the development and prognosis of critically ill patients (CIP). CIP are those who require high reliance or serious medical and/or surgical interventions. For their importance, valid and reliable nutritional markers are mandatory to be implemented in the daily practice of our PICU. The aim of this study was to determine the nutritional status of CIP in PICU through measuring prealbumin level and use it as predictor of malnutrition and clinical outcome. Forty four CIP admitted to the Children's Hospital, Cairo University PICU, throughout six months were the subject of this cross-sectional study. Clinical nutritional status was evaluated using the Z-score, and prealbumin level was measured. 50% of children who were critically sick also had malnutrition, with severe malnutrition accounting for the majority of cases (34.1%). Prealbumin did not significantly correlate with malnutrition, nor the mortality in CIP. However, malnutrition is strongly linked to mortality in critically ill children. To predict malnutrition in CIP, serum prealbumin at cutoff > 163.64 exhibited AUC of 0.556 with sensitivity of 90.91% and a specificity of 31.82%. For prediction of the clinical outcome, serum prealbumin at cutoff ≤ 758.37 had an AUC of 0.535 with a sensitivity of 91.67% and a specificity of 21.87%. Malnutrition significantly increased the risk of death. Prealbumin was neither a significant predictor for malnutrition nor mortality in CIP.