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

Abstract

Objectives: To compare 5% albumin with 0.9% saline for large-volume resuscitation (> 60 mL/Kg within 24 hr), on mortality and development of acute kidney injury.

Design: Retrospective cohort study.

Setting: Patients admitted to ICUs in 13 hospitals across Western Pennsylvania. We analyzed two independent cohorts, the High-Density Intensive Care databases: High-Density Intensive Care-08 (July 2000 to October 2008, H08) and High-Density Intensive Care-15 (October 2008 to December 2014, H15).

Patients: Total of 18,629 critically ill patients requiring large-volume resuscitation.

Interventions: Five percent of albumin in addition to saline versus 0.9% saline.

Measurements and main results: After excluding patients with acute kidney injury prior to large-volume resuscitation, 673 of 2,428 patients (27.7%) and 1,814 of 16,201 patients (11.2%) received 5% albumin in H08 and H15, respectively. Use of 5% albumin was associated with decreased 30-day mortality by multivariate regression in H08 (odds ratio 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 acute kidney injury in H08 (odds ratio 1.98; 95% CI 1.56-2.51; p < 0.001) and in H15 (odds ratio 1.75; 95% CI 1.58-1.95; p < 0.001). However, 5% albumin was not associated with persistent acute kidney injury and resulted in decreased major adverse kidney event at 30, 90, and 365 days. Propensity matched analysis confirmed similar associations with mortality and acute kidney injury.

Conclusions: During large-volume resuscitation, 5% albumin was associated with reduced mortality and major adverse kidney event at 30, 90, and 365 days. However, a higher rate of acute kidney injury of any stage was observed that did not translate into persistent renal dysfunction.

Trial registration: ClinicalTrials.gov NCT02641119.

Conflict of interest statement

Dr. Gomez’s institution received funding from the National Institutes of Health (NIH)/National Institute of General Medical Sciences K08 grant 1K08GM117310-01A1 and TES Pharma. Drs. Gomez, Bataineh, Clermont, and Kellum received support for article research from the NIH. Drs. Bataineh’s and Kellum’s institutions received funding from Grifols and the NIH. Dr. Clermont received funding from the NIH and the National Science Foundation, and he disclosed that he is also Chief Medical Officer and owns equity in NOMA AI Inc. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Copyright © 2020 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Figures

Figure 1:

CONSORT diagram for HiDenIC08 (A), and HiDenIC15 (B).

Figure 1:

CONSORT diagram for HiDenIC08 (A), and HiDenIC15 (B).

Figure 2:

Adjusted survival (cox model) by treatment group in HiDenIC15