Effects of 5% Albumin Plus Saline Versus Saline Alone on Outcomes From Large-Volume Resuscitation in Critically Ill Patients (original) (raw)

Critical Care Medicine, 2020

Abstract

Objective:To compare 5% albumin to 0.9% saline for large-volume resuscitation (LVR, > 60ml/Kg within 24h), on mortality and development of acute kidney injury (AKI).Design:Retrospective cohort study.Setting:Patients admitted to intensive care units (ICUs) in 13 hospitals across Western Pennsylvania. We analyzed two independent cohorts, the High-Density Intensive Care (HiDenIC) databases: HiDenIC08 (July 2000 to October 2008, H08) and HiDenIC15 (October 2008 to December 2014, H15).Patients:Total of 18,629 critically ill patients requiring LVR.Interventions:5% albumin in addition to saline vs 0.9% saline.Measurements and Main Results:After excluding patients with AKI prior to LVR, 673/2,428 (27.7%) and 1,814/16,201 (11.2%) patients received 5% albumin in H08 and H15, respectively. Use of 5% albumin was associated with decreased 30-day mortality by multivariate regression in H08 (OR 0.65, 95% CI 0.49–0.85, p=0.002) and in H15 (0.52, 95% CI 0.44–0.62, p<0.0001), but was associated with increased AKI in H08 (OR 1.98, 95% CI 1.56–2.51, p<0.001) and in H15 (OR 1.75, 95% CI 1.58–1.95, p<0.001). However, 5% albumin was not associated with persistent AKI, and resulted in decreased MAKE at 30, 90 and 365 days. Propensity matched analysis confirmed similar associations with mortality and AKI.Conclusion:During LVR, 5% albumin was associated with reduced mortality and MAKE at 30, 90 and 365 days. However, a higher rate of AKI of any stage was observed that did not translate into persistent renal dysfunction.

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