Early Albumin Administration May Reduce Mortality in Septic Shock and ARDS: Retrospective MIMIC III Database Study
Investigators found that early albumin administration in septic shock patients with ARDS was independently associated with a reduction in 28-day mortality, and that its survival benefit appeared to be more pronounced in patients with a SOFA score of ≤10.
- By BSTQ Staff
Acute respiratory distress syndrome (ARDS), a frequent complication of septic shock (SS), involves the rapid onset of hypoxemia and bilateral pulmonary edema caused by increased alveolocapillary permeability. ARDS patients have the characteristics of hypoalbuminemia, which may impact the progression of pulmonary edema. While a recent meta-analysis indicated that early administration of albumin to ARDS patients could decrease alveolar-capillary leakage and improve oxygenation, it is also known that tissue edema may be exacerbated by the extravasation of colloid molecules in patients with high capillary leakage.
The investigators, therefore, aimed to determine if early human albumin administration can improve survival in septic shock patients with ARDS using the Medical Information Mart for Intensive Care (MIMIC) III database, a large open-source U.S. medical record database publicly available in PhysioNet.
The 28-day mortality rate in 135 patients who received albumin was significantly lower than in 730 patients not treated with albumin (37% versus 47%, p = 0.018). After propensity matching, the difference between the two groups remained significant (34.8% versus 48.1%, p = 0.031). At 90 days, mortality in the albumin group remained lower than in the non-albumin group (42.2% versus 68.2%, p < 0.01).
The relationship between early albumin treatment and lower mortality remained significant in prespecified subgroups, including age <75 or ≥75 years; presence or absence of heart failure; absence of renal failure; non-glucocorticoid use; a SOFA score ≤10; or mild or moderate hypoxemia. However, the association was insignificant in subgroups with glucocorticoid use, renal failure, severe hypoxemia or a SOFA score >10.
The investigators concluded that early albumin administration in septic shock patients with ARDS was independently associated with a reduction in 28-day mortality, and that its survival benefit appeared to be more pronounced in patients with a SOFA score of ≤10.
References
Wang, X, Zhang, T, Gao, X, et al. Early Human Albumin Administration Is Associated with Reduced Mortality in Septic Shock Patients with Acute Respiratory Distress Syndrome: A Retrospective Study from the MIMIC-III Database. Frontiers in Physiology, 2023 Apr 7;14:1142329.
