Early Albumin Exposure After Cardiac Surgery

Objectives: To determine whether the early use of albumin after cardiac surgery in the first 24 hours in the intensive care unit (ICU) is associated with reduced mortality. Design: A single-center nonrandomized retrospective cohort study using the Medical Information Mart in Intensive Care IV database. Setting: A single cardiothoracic ICU in the United States during a period between 2008 to 2019. Participants: Patients undergoing valvular and/or cardiac bypass graft surgeries. Interventions: Albumin administered during the first 24 hours of the ICU admission. Measurements and Main Results: A total of 8,136 patients were included in this study, of whom 4,444 (54.6%) received albumin at any stage during the first 24 hours of ICU admission, and 69 (1.6%) of those patients died. The patient population exposed to albumin had higher comorbidities and illness severity compared to the no-albumin group. Patients exposed to albumin during the first 24 hours of ICU admission had a statistically significant reduction in mortality (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.48-0.97, p < 0.05) after adjustment for age, the Oxford Acute Severity of Illness Score, and the Charlson comorbidity index. A sensitivity analysis of patients who received albumin at any stage during ICU admission showed increased mortality (OR, 1.93; 95% CI, 1.26-3.07, p < 0.01). Patients exposed to albumin had a significant increase in adjusted ICU length of stay (LOS) (geometric mean ratio 1.09; 95% CI, 1.05-1.10, p = < 0.001) and hospital LOS (geometric mean ratio 1.08; 95% CI, 1.05-1.10, p < 0.001). Conclusions: Exposure to albumin in the first 24 hours after cardiac surgery is associated with a reduction in adjusted hospital mortality and an increase in both hospital and ICU lengths of stay. (c) 2021 Elsevier Inc. All rights reserved.

Automated summary

Early use of albumin after cardiac surgery may be associated with reduced mortality, but it increases hospital and ICU lengths of stay.