الفهرس 
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Abstract
Albumin is the most abundant protein in human plasma with diverse functions including antioxidant activity, buffering properties, binding and transport capacities for numerous substances (Fanali et al., 2012). Albumin is synthesized in the liver as preproalbumin,then the product, proalbumin, is in turn cleaved in the Golgi vesicles to produce the secreted albumin (Mendez et al., 2005).
The reference range for albumin concentrations in serum is approximately 3.5-5 g/dL (35-50 g/L). Serum albumin (CP) is the serum analyte that best predicts a poor outcome. Serum albumin also predicts mortality in healthy individuals (Banks et al., 2010).
Inflammation is a part of the complex biological response of body tissues to harmful stimuli. The function of inflammation is to eliminate the initial cause of cell injury, clear out necrotic cells and tissues damaged from the original insult and the inflammatory process and initiate tissue repair (Ferrero-Miliani et al., 2007).
The role of sepsis markers in diagnosing sepsis, the availability of accurate sepsis biomarkers to facilitate diagnosis could be of use to enable timely appropriate treatment to be started, thus optimizing a patient’s chances of survival (Pierrakos and Vincent, 2014).
Procalcitonin is a 116 amino acid peptide that has an approximate MW of 14.5 kDa and belongs to the calcitonin (CT) superfamily of peptides. Procalcitonin is encoded by CALC-1 gene located on chromosome 11 (Ming and Khan, 2010). A microbial infection induces a substantial increase of CALC-1 gene expression in all parenchymal tissue and differentiated cell types in the body producing PCT. Its levels increase significantly in sepsis, systemic infection and severe inflammation, the serum levels of ProCT usually increase markedly (Müller et al., 2000).
The aim of the study is to determine the relationship between reduced albumin and inflammatory response and its effect on morbidity and mortality in critically ill patients.
Patients and methods
This is a prospective randomized study that was conducted on patients who were admitted to ICU in Ain Shams University Hospitals. Forty three patients were included in this study and an informed written consent was obtained from patients and/or relatives.
All patients were adult, more than 18 years old, admitted to ICU, with critical illness that have clinical picture of inflammation.
We excluded Patients less than18 years old, patients or relatives refused, to be included in this study, nephrotic syndrome patients, hepatic cirrhosis patients, heart failure patients and malnutrition patients.
All patients were subjected to assessment of the demographic data of the patient, ICU length of stay (days), hemodynamic data: heart rate, mean blood pressure and temperature were assessed 3 times daily for seven days. Serum albumin level in the first, third and seventh days, CRP level, TLC and ESR in the first ,third and seventh days, procalcitonin level in the first and seventh days, blood gases and lactate level in the first, third and seventh days, morbidity and mortality, causes and site of infection.
Forty three patients were included in this study shows the demographic data of studied patients with mean age of survivors was 53.47 ± 14.26 years and 10 (53%) of them were males where mean age of non-survivors was 56.79± 11.766 years and 13 (68%) of them were males.
It was noticed that albumin level was significantly increased at 7th days in comparison to 1st day in case of survivors but in case of non- survivor it showed significant decrease.
It was noticed that pro-calcitonin was significantly increased at 7th days in comparison to 1st day in case of non- survivors but in case of survivor it showed significant decrease. It was noticed that serum albumin had negative significant correlation with baseline inflammatory markers; CRP (r= -0.65; P= 0.04), ESR (r= -0.45; P= 0.01), TLC (r= -0.42; P= 0.01) and Procalcitonin (r= -0.34; P= 0.02).