Albuminemia Significantly Affects Clinical Outcomes in Patients with Severe Traumatic Brain Injury (TBI)

Objective: Albumin levels (ALBs) influence clinical outcomes in severe traumatic brain injury (TBI). This study investigates the relationship between ALBs and clinical outcomes to improve prognosis and guide management. Method: This is a single-center, retrospective study of patients with severe TBI from 1 January 2020 to 31 December 2023. ALBs were measured at the following times: Hospital admission (TA), ICU admission (RL1), ICU discharge (RL2), hospital discharge (HD), and patient death (PD) if applicable. Patient descriptors and clinical outcomes such as gender, age, race, hospital length of stay (HLOS), ICU length of stay (ICU LOS), ventilation days (VD), Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and mortality were assessed. Results: ALBs were grouped into the following categories: Extreme hyperalbuminemia (≥ 5.5 g/dL), hyperalbuminemia (4.7-5.4 g/dL), normal albuminemia (3.5-4.7 g/dL), hypoalbuminemia (2.5-3.5 g/dL), and extreme hypoalbuminemia (< 2.5 g/dL). Among 925 severe-TBI patients (76 % male; mean age = 53 y), admission albumin was normal (3.5–4.7 g dL⁻¹) in 65.0 %, hypoalbuminemic (< 3.5 g dL⁻¹) in 25.2 %, and hyperalbuminemic (> 4.7 g dL⁻¹) in 9.4 %. By ICU discharge, albumin shifted upward: extreme hyperalbuminemia (≥ 5.5 g dL⁻¹) 62.6 %, hyperalbuminemia 15.8 %, normoalbuminemia 20.4 %, and hypoalbuminemia ≤ 1.3 %. In-hospital mortality was 12.7 % (117/925) and did not vary by either admission or discharge albumin category (χ² = 3.47, p = 0.32). Median hospital length of stay was 5 d (IQR ≈ 11 d), ICU stay 1.3 d, and ventilator use 0 d; none differed significantly across albumin strata (all Kruskal–Wallis p > 0.10). Conclusions: Although serum ALBs changed substantially during acute care with shifting from frequent hypoalbuminemia on admission to predominant hyperalbuminemia at ICU discharge, albumin concentration was not independently associated with mortality or resource utilization. In modern neuro-critical practice, where protein deficits are rapidly corrected, albumin serves mainly as a therapeutic target rather than a stand-alone prognostic marker in severe TBI.