Serum Albumin in Critical Care in Cameroon: A Critical Synthesis of Its Prognostic Value and Its Role in Risk Stratification in Critically Ill Patients

Background: Hypoalbuminemia is common in critically ill patients and is consistently associated with adverse outcomes, including mortality, complications, and prolonged length of stay. Its interpretation remains challenging because serum albumin levels are influenced by inflammation, increased capillary permeability, and hemodilution. Objective: To provide a critical narrative synthesis of the role of serum albumin as a prognostic marker rather than a therapeutic target, and to discuss its potential value for frugal risk stratification in critical care in Cameroon. Methods: This narrative review was based on a targeted literature search (PubMed/PMC and DOI.org) and a reasoned selection of pivotal randomized controlled trials, meta-analyses, and international guidelines, complemented by the limited, published, and verifiable Cameroonian data. The approach was deliberately non-exhaustive and did not follow a systematic review protocol. Results: Serum albumin emerges as a robust prognostic marker, showing a dose-response association with outcomes and acting as a signal for the risk of acute kidney injury. Major randomized controlled trials in critical care do not support a universal strategy of albumin “correction” (SAFE, ALBIOS). A signal of increased mortality has been reported in traumatic brain injury when albumin is used as a resuscitation fluid. In the Cameroonian setting, the possible coexistence of low baseline albumin levels related to undernutrition and acute decreases driven by inflammation supports a contextualized interpretation integrated with clinical indices of organ dysfunction. Conclusion: Serum albumin represents a potentially relevant and frugal prognostic stratification tool in Cameroon, provided that prospective local validation is performed and that its interpretation remains physiopathologically cautious; it should not, on its own, dictate therapeutic strategies.