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. 2021 Mar 10;11(1):42.
doi: 10.1186/s13613-021-00830-8.

Early combination of albumin with crystalloids administration might be beneficial for the survival of septic patients: a retrospective analysis from MIMIC-IV database

Shiyu Zhou #  1 , Zhenhua Zeng #  2 , Hongxia Wei  1 , Tong Sha  2 , Shengli An  3
Affiliations

Early combination of albumin with crystalloids administration might be beneficial for the survival of septic patients: a retrospective analysis from MIMIC-IV database

Shiyu Zhou et al. Ann Intensive Care. .

Abstract

Background: Fluid therapy is a cornerstone in the treatment of sepsis. Recently, the guidelines have recommended the combined administration that using crystalloids plus albumin for septic patients, but the optimal timing for albumin combined is still unclear. The objective of this study was to investigate the association of timing of albumin combined with 28-day mortality in patients with sepsis.

Methods: We involved septic patients from the Medical Information Mart for Intensive Care (MIMIC)-IV database, and these patients were categorized into crystalloids group (crystalloids alone) and early combination group (crystalloids combined albumin at 0-24 h). The primary outcome was 28-day mortality. We used propensity score matching (PSM) to adjust confounding and restricted mean survival time (RMST) analysis was conducted to quantify the beneficial effect on survival due to the combination group.

Results: We categorized 6597 and 920 patients in the "crystalloids alone" and "early combination", respectively. After PSM, compared to the crystalloids group, the combination group was associated with the increased survival among 28-day (increased survival: 3.39 days, 95% CI 2.53-4.25; P < 0.001) after ICU admission. Patients who received albumin combination at the first 24-h was associated with prolonged LOS in ICU (10.72 days vs. 8.24 days; P < 0.001) but lower risk of 28-day mortality (12.5% vs 16.4%, P = 0.003) than those received crystalloids alone.

Conclusion: In septic patients, receiving albumin combined within the first 24-h after crystalloids administration was associated with an increment of survival in 28 days.

Keywords: Albumins; Fluid therapy; Mortality; Restricted mean survival time; Sepsis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study flowchart. MIMIC Medical Information Mart for Intensive Care
Fig. 2
Fig. 2
Kaplan–Meier survival curve of the two groups. Shaded regions are the difference of restricted mean survival time (RMST) for two groups among 28 (a, c), 60 (b, d) days before and after propensity score matching (1:1), means the increment of survival days due to the combination therapy among 28 and 60 days. Combination group: patients who received albumin within the first 24 h after initiation of crystalloids administration. Crystalloids group: patients who received crystalloids alone as fluid therapy
Fig. 3
Fig. 3
Association of increased survival and the combination group before propensity score matching. The difference in days (95%CI): The difference of restricted mean survival time (RMST) between the two groups (RMSTcombination-RMSTcrystalloids), means the increment or reduction of survival owing to the combination therapy. The preceded combination group (< 0 h) is defined as patients who received the albumin solution as the initiation of fluid administration and subsequently combined with crystalloids. The late combination group (> 24 h) is defined as patients who received the albumin greater than 24 h after crystalloids administration
Fig. 4
Fig. 4
Total volume of fluid administration for each group. *: significant
Fig. 5
Fig. 5
Length of stay in ICU and hospital for each group. *: significant
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