We investigated the possible association between albumin administration and worse outcome in a large cohort of ICU patients.
All 3147 adult patients admitted to 198 European ICUs between May 1 and 15, 2002 were followed up until death, hospital discharge, or for 60 days. Patients were classified into those who received albumin at any time during their ICU stay and those who did not. Propensity score case-matching was performed with matched pairs examined for baseline characteristics and outcome.
Three hundred fifty-four patients (11.2%) received albumin. On admission, patients who received albumin had a higher incidence of cancer and liver cirrhosis, were more commonly medical admissions, had higher SAPS II and SOFA scores, and had a higher incidence of sepsis syndromes. As expected, ICU and hospital mortality rates were higher in the albumin group (35.3 vs. 16.4, and 41.5 vs. 21.3%, p<0.001) than in other patients. In a Cox regression analysis with ICU mortality at 60 days as the dependent factor, albumin administration was an independent risk factor for death (relative hazard 1.4, 95% confidence interval 1.2–1.8, p<0.001) at 60 days. Moreover, in 343 propensity matched pairs, ICU and hospital mortality rates were higher in patients who received albumin than in those who did not (34.7 vs. 20.7 and 41.1 vs. 25.7%, p<0.001). Survival at 30 days was lower in the albumin group than in its matched group (Log Rank 6.9, p<0.001). Albumin administration was associated with a higher relative hazard of death at 60 days across all subgroups of age, SAPS II and fluid balance (relative hazard >1, p<0.01).CONCLUSIONS: In this observational study, albumin administration was associated with increased mortality.
The use of albumin in critically ill patients may be associated with increased mortality and requires further evaluation by prospective randomized trials.
J. Vincent, None.