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

Abstract

Objective: The objective of this study was to evaluate the association between serum albumin levels and microcirculation changes, glycocalyx degradation, and the clinical outcomes of interest. Methods: Observational, prospective study in children with sepsis. The primary outcome was the association between hypoalbuminemia and microcirculation disorders, endothelial activation and glycocalyx degradation using a perfused boundary region (PBR) (abnormal >2.0 μm on sublingual video microscopy) or plasma biomarkers (syndecan-1, angiopoietin-2). Results: A total of 125 patients with sepsis were included. The median age was 2.0 years (IQR 0.5–12.5). Children with hypoalbuminemia had more abnormal microcirculation with a higher PBR (2.16 μm [IQR 2.03–2.47] vs. 1.92 [1.76–2.28]; p =.01) and more 4–6 μm capillaries recruited (60% vs. 40%; p =.04). The low albumin group that had the worst PBR had the most 4–6 μm capillaries recruited (rho 0.29; p