Admission albumin in burns tracks mortality and acute kidney injury

Design

systematic review of 19 studies with meta-analysis of 9

Population

patients admitted with burn injury and albumin measured on admission

Primary outcome

in-hospital mortality, with acute kidney injury and other morbidity secondary

Effect

mortality odds ratio 9.51 (95% CI 3.04-29.78, I squared 49.3%); acute kidney injury 2.83 (2.49-3.22, I squared 0%)

Nineteen studies were reviewed and nine pooled to test whether serum albumin measured on admission predicts outcome after burn injury. Hypoalbuminaemia at admission was associated with in-hospital mortality at an odds ratio of 9.51 (95% CI 3.04 to 29.78, I squared 49.3%) and with acute kidney injury at 2.83 (2.49 to 3.22, I squared 0%). Evidence for length of stay, ventilatory requirement, sepsis and pulmonary infection was limited and inconsistent.

The mechanism is not mysterious. Capillary leak after a large burn drives albumin out of the intravascular space, so a low admission albumin is partly a measure of how much burn there is and how leaky the patient already is. That makes it a marker rather than a target, and the review says explicitly that no optimal cut-off has been established and that the trajectory over the first 24 hours has not been characterised.

Where it earns a place is triage in units without formal burn scoring, which describes many receiving hospitals in India. Albumin is cheap, already on the admission panel, and adds information to total body surface area and inhalational injury. It should raise the intensity of monitoring and the threshold for transfer, not prompt albumin infusion - nothing here tests giving albumin, and the fluid resuscitation question is separate and contested.

• Read admission albumin alongside burn surface area and inhalational injury, not instead of them
• Let a low admission albumin raise monitoring intensity and lower the threshold for transfer to a burns unit
• Watch renal function specifically - the AKI association was the most consistent finding
• Do not treat the number by infusing albumin; this review tested prognosis, not therapy
• Repeat the measurement rather than acting on a single value; the trajectory is uncharacterised but likely more informative

Why it matters

It gives a receiving unit without a formal burn score a cheap second variable that is already on the admission bloods.

Don't overread it

This is prognostic association only - no cut-off is validated, and nothing here supports giving albumin.

The statistics, in plain English

An odds ratio of 9.51 with an interval running from 3.04 to 29.78 is a strong association measured very imprecisely - the true value could be a threefold or a thirtyfold increase in odds, and pooled heterogeneity of nearly 50% means the studies differed. The AKI estimate is the more usable one: tighter interval, no heterogeneity. Note too that odds ratios overstate risk when the outcome is common, as death is in severe burns, so these should not be read as relative risks.

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