Association of Serum Albumin Level and Mortality in Premature Infants

J Clin Lab Anal. 2016 Nov;30(6):867-872. doi: 10.1002/jcla.21949. Epub 2016 Apr 13.


Background: Hypoalbuminemia has been proven to be a powerful predictor of mortality in adult patients. However, prognostic value of serum albumin in neonates is not clear.

Objective: To assess the relationship between serum albumin level within the first day of life and outcome in preterm infants born before 32 weeks of gestation.

Methods: The study was conducted prospectively in Baskent University Hospital between October 2008 and November 2009. Patients were divided by gestational age into two groups as below or of 28 weeks and above 28 weeks. Then serum albumin percentile groups were established within each gestational age group and were defined as <25, 25-75, and >75 percentile groups by combining percentile groups between the two gestational age groups. Three serum albumin percentile groups were compared regarding neonatal outcomes.

Results: A total of 199 infants with mean birth weight of 1,272 ± 390 g and mean gestational age of 29.2 ± 2.2 weeks were admitted to the study. The mean serum albumin level was 30.6 ± 4.7 g/l for all patients. The mean serum albumin levels were 25.5 ± 3.8, 30.1 ± 2.7, and 35.3 ± 3.7 g/l for <25, 25-75, and >75 percentile groups, respectively. Prevalence of infants with respiratory distress syndrome and prevalence of infants with sepsis and mortality were significantly higher in <25 percentile group. Logistic regression analysis showed that serum albumin <25 percentile and birth weight were independent predictive variables of mortality. Albumin concentrations lower than 27.2 g/l was associated with mortality, with a sensitivity of 71% and a specificity of 86%.

Conclusion: Low serum albumin level within the first day of life is an independent predictor of mortality in preterm infants.

Keywords: hypoalbuminemia; mortality; neonate; preterm.

MeSH terms

  • Birth Weight
  • Cohort Studies
  • Female
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Infant, Newborn, Diseases / mortality
  • Infant, Premature / blood*
  • Logistic Models
  • Male
  • Predictive Value of Tests
  • Premature Birth / blood*
  • Premature Birth / mortality*
  • ROC Curve
  • Serum Albumin / metabolism*


  • Serum Albumin