Association Between Albumin Levels and Neonatal Acute Respiratory Distress Syndrome in Newborn Pneumoniae

Abstract

Objective: This study aims to investigate the relationship between serum albumin levels and neonatal acute respiratory distress syndrome (NARDS) in patients with newborn pneumonia, providing new insights for clinical interventions targeting NARDS.

Methods: A retrospective analysis of medical records of neonatal pneumonia patients admitted to the neonatal intensive care unit (NICU) at a tertiary medical institution from January 2021 to December 2023 was conducted. Patients were stratified based on hypoalbuminemia (defined as serum albumin levels < 35 g/L), clinical thresholds, and albumin level quartiles. To eliminate the impact of potential confounding factors on the results, multivariable logistic regression and propensity score matching (PSM) analyses were performed to calculate the adjusted odds ratio (OR) and 95% confidence interval (95% CI) for the occurrence of NARDS in these patients. Additionally, subgroup analyses were conducted to explore interaction effects.

Results: In this retrospective cohort study, a total of 342 patients with neonatal pneumonia admitted to the NICU were included. The multivariable logistic regression analysis revealed that the incidence of NARDS in patients with hypoalbuminemia was significantly higher than in those with normal albumin levels (OR = 2.16, 95% CI 1.47-4.06, p = 0.017). Compared to patients in quartile Q1 (≥39 g/L), those in quartile Q4 (≤33 g/L) exhibited a significantly increased risk of NARDS (OR = 4.40, 95% CI 1.53-12.63, p = 0.006). After conducting PSM, these associations remained significant. Furthermore, treating serum albumin levels as a continuous variable revealed that each 1 g/L increase was associated with a 17% reduction in NARDS risk (95% CI, 1.08-1.15).

Conclusion: Low serum albumin levels in patients with neonatal pneumonia are closely associated with NARDS, indicating a significant dose-response relationship between the two.

Keywords: albumin; hypoalbuminemia; neonatal; neonatal acute respiratory distress syndrome; newborn pneumoniae.

Figure 1

Flow diagram for the present study.

Figure 2

Relationship between different albumin level groups and NARDS rates in patients with neonatal pneumoniae. (A) The incidence of NARDS was 20.9% in the group with normal preoperative serum albumin levels, and 41.9% in the hypoalbuminemia group. (B) Patients were divided into 4 quartiles, comparing NARDS rates among the 4 quartiles. Q1:12.7%; Q2:29.2%; Q3:23.5%; Q4:47.6%. (C) Patients were categorized into 4 groups using clinical thresholds, comparing NARDS rates among the 4 groups. C1: 20.9%; C2: 35.8%; C3: 88.2%; C4: 100%.

Figure 3

For a line plot depicting the relationship between serum albumin levels in NARDS patients. (A) The restricted cubic spline plot was used to demonstrate the association between serum albumin levels and NARDS. The Y-axis represents the adjusted odds ratio, while the X-axis indicates serum albumin levels. The model has been adjusted for all included covariates. The shaded red area signifies the 95% confidence intervals. The critical value of OR = 1 is denoted by the point. (B) The plot illustrates the relationship between serum albumin levels and the predicted probability of NARDS. The Y-axis represents the predicted probability, while the X-axis indicates serum albumin levels. The shaded red area signifies the 95% confidence intervals.

Figure 4

Subgroup analysis was performed to evaluate potential interaction between hypoalbuminemia and each covariate. A value of p less than 0.01 was considered statistically significant. (A) Subgroup analysis of variables related to laboratory tests. (B)Subgroup analysis of variables related to perinatal factors (C) Subgroup analysis of variables related to demographics.