Transl Pediatr. 2026 Apr 30;15(4):108. doi: 10.21037/tp-2026-1-0008. Epub 2026 Apr 28.
ABSTRACT
BACKGROUND: Albumin is a key protein essential for maintaining multiple physiological functions. During extracorporeal membrane oxygenation (ECMO) support, serum albumin concentration may decline as a result of hemodilution or capillary leakage. This reduction may be more pronounced in pediatric patients, whose hepatic synthetic function is not fully mature. However, evidence regarding the association between serum albumin concentration and clinical outcomes in pediatric postcardiotomy ECMO patients remains limited. This study aims to explore this association in pediatric patients.
METHODS: This single-center retrospective study included 96 pediatric patients who underwent veno-arterial ECMO (VA-ECMO) after cardiac surgery. The association between nadir albumin concentration during ECMO and 30-day and 180-day mortality was explored using Cox regression model. Additionally, exploratory analyses were performed to assess the relationship between albumin concentration and ECMO-related complications using logistic regression, aiming to further characterize potential factors associated with lower nadir albumin concentration and mortality. Subgroup and sensitivity analyses were performed to assess robustness.
RESULTS: In this study, the median age at ECMO initiation was 12.42 months [interquartile range (IQR): 6.42-40.06], with 64% being male. Overall, 30-day and 180-day mortality rates were 37.5% and 52.1%. Nadir albumin concentration was found to be inversely associated with the risk of 30-day [hazard ratio (HR): 0.924, 95% confidence interval (CI): 0.866-0.987] and 180-day mortality (HR: 0.929, 95% CI: 0.880-0.981). Exploratory analyses suggested no statistically significant associations between nadir albumin concentration and continuous renal replacement therapy (CRRT), hemolysis, thrombosis, major bleeding, and liver injury. Subgroup analyses showed no significant interactions by age, weight, or the Society of Thoracic Surgeons and European Association for Cardiothoracic Surgery Congenital Heart Surgery (STAT) Mortality Categories. Sensitivity analyses restricted to patients with early nadir occurrence and excluding those without albumin supplementation yielded consistent results.
CONCLUSIONS: In pediatric patients receiving postcardiotomy ECMO support, a lower nadir albumin concentration was independently correlated with an elevated risk of mortality and may serve as a readily available marker for risk stratification, warranting validation in prospective studies.
PMID:42158704 | PMC:PMC13181657 | DOI:10.21037/tp-2026-1-0008