Pediatric Hypoprotienemia and its Implications on Surgical Outcome, Vital Organs Function and Immunity after Cancer Surgeries

Background: Hypoprotienemia is associated with poor outcomes in adult critical illness, but whether this association exists in pediatric patients remains unclear. There is a paucity of data evaluating serum albumin level on admission as a predictor of outcome in critically ill children.
Objectives: To determine or to investigate the effect of hypoprotienemia in surgical outcome, vital organs function and immunity in patients undergoing major cancer surgery.

Study Design: A Randomized double-blinded trial.

Setting: Academic medical center.

Methods: Forty pediatric patients underwent elective oncological surgery were divided into two groups. Group I: serum albumin >35 g/L and Group II: serum albumin ≤ 35 g/L. Preoperative level of IL1, total lymphocytic count and neutrophilic count were determined. patients were monitored daily for major postoperative complications, including, renal failure, heart failure, respiratory failure, pneumonia/respiratory tract infection, major thromboembolic event, wound infection / dehiscence, anastamotic leak and fistula formation.
SOFA score was recorded on the day of admission to the ICU and every 48 hours until discharge. The length of stay in the ICU was measured from admission to the ICU until discharge. Complete blood pictureliver function, interleukin IL6 and kidney function were done on first, third, fifth and seventh postoperative day.

Results: Postoperative complications were more frequent in group II compared to group I. Also, the length of ICU stay was proved to be significantly longer in group II (10.60 ± 3.59 days) compared to group I (7.95 ± 0.69 days) (P = 0.002**). Serum IL6 levels were significantly higher in group II compared to group I on first, third and seventh postoperative days (P = 0.001**). There was no statistically significant difference between two groups in Total lymphocytic count in all follow up days and statistically significant increase in neutrophilic count on group II compared to group I on first, third and seventh postoperative days. Finally there was a statistically significant increase in SOFA score in group II compared to group I in all follow up days.

Limitations: This study is limited by its small sample size.

Conclusion: Hypoprotienemia increases the risk of postoperative complications and impaired vital organs dysfunction leading to prolongation of ICU stay in ICU after pediatric cancer surgery.

Keywords: Hypoprotienemia; ICU; pediatric cancer surgery; SOFA score.