TITLE:
Low Serum Albumin as a Determinant of Mortality in Shock: A Systematic Review and Meta-Analysis of Global Evidence
AUTHORS:
Jackson Rashid Djuma, Claudine Malonga, Deogratias Mulungulungu, Marc Habunamboka Kilonda, Jean Charles Preiser
KEYWORDS:
Hypoalbuminemia, Shock, Mortality
JOURNAL NAME:
Open Journal of Emergency Medicine,
Vol.13 No.4,
November
7,
2025
ABSTRACT: Background: Hypoalbuminemia is a hallmark of critical illness, reflecting both systemic inflammation and impaired homeostasis. This systematic review and meta-analysis examine the prognostic significance of low serum albumin in shock patients, integrating data from diverse global cohorts. Methods: Comprehensive searches of PubMed, Europe PMC, and Google Scholar were conducted (2019-2025) to identify studies reporting adjusted odds ratios (ORs) or hazard ratios (HRs) for the association between hypoalbuminemia and mortality in adult shock patients. Separate random-effects meta-analyses were performed for ORs and HRs. Heterogeneity was quantified with I2 statistics, and meta-regression was applied to explore study-level covariates. Results: Eleven studies met inclusion criteria (n = 7 OR studies; n = 4 HR studies). Pooled ORs and HRs each demonstrated a robust association between low serum albumin and increased mortality, independent of major confounders. Sensitivity analyses confirmed the stability of findings. Age significantly modified OR-based associations, while continental location showed borderline influence in HR models. Conclusions: Low serum albumin is a powerful, independent prognostic biomarker in shock. These findings reinforce albumin’s potential utility in risk stratification and therapeutic decision-making in critical care.