Adam J Kingeter1, Karthik Raghunathan2, Sibyl H Munson3, David K Hayashida3, Xuan Zhang3, Sloka Iyengar3, Martin Bunke4, Andrew D Shaw5. 1. Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Avenue South MAB 422, Nashville, TN, 37232-5614, USA. adam.kingeter@vanderbilt.edu. 2. Duke University Medical Center and Durham VA Medical Center, Durham, NC, USA. 3. Boston Strategic Partners, Inc., Boston, MA, USA. 4. Grifols, Inc., Research Triangle Park, NC, USA. 5. University of Alberta, Edmonton, AB, Canada.
Abstract
PURPOSE: Albumin is widely used during and after on-pump cardiac surgery, although it is unclear whether this therapy improves clinical outcomes. METHODS: This observational study utilized the Cerner Health Facts® database (a large HIPAA-compliant clinical-administrative database maintained by Cerner Inc., USA) to identify a cohort of 6,188 adults that underwent on-pump cardiac surgery for valve and/or coronary artery procedures between January 2001 and March 2013. Of these, 1,095 patients who received 5% albumin with crystalloid solutions and 1,095 patients who received crystalloids alone on the day of or the day following cardiac surgery were selected by propensity-score matching. The primary outcome was all-cause in-hospital mortality. Three secondary outcomes analyzed include acute kidney injury severity, major morbidity composite, and all-cause 30-day readmissions. RESULTS: In the propensity-score matched cohort, receipt of perioperative 5% albumin was associated with decreased risk of in-hospital mortality (odds ratio [OR], 0.5; 95% confidence interval [CI], 0.3 to 0.9; P = 0.02) and lower all-cause 30-day readmission rates (OR, 0.7; 98.3% CI, 0.5 to 0.9; P < 0.01). Albumin therapy was not associated with differences in overall major morbidity (OR, 0.9; 98.3% CI, 0.7 to 1.2; P = 0.39; composite) or acute kidney injury severity (OR, 0.9; 98.3% CI, 0.6 to 1.4; P = 0.53) compared with therapy with crystalloid solutions. CONCLUSIONS: In this large retrospective study, use of 5% albumin solution was associated with significantly decreased odds of in-hospital mortality and all-cause 30-day readmission rate compared with administration of crystalloids alone in adult patients undergoing on-pump cardiac surgery. These results warrant further studies to examine fluid receipt, including 5% albumin, in surgical populations via randomized-controlled trials.
PURPOSE: Albumin is widely used during and after on-pump cardiac surgery, although it is unclear whether this therapy improves clinical outcomes. METHODS: This observational study utilized the Cerner Health Facts® database (a large HIPAA-compliant clinical-administrative database maintained by Cerner Inc., USA) to identify a cohort of 6,188 adults that underwent on-pump cardiac surgery for valve and/or coronary artery procedures between January 2001 and March 2013. Of these, 1,095 patients who received 5% albumin with crystalloid solutions and 1,095 patients who received crystalloids alone on the day of or the day following cardiac surgery were selected by propensity-score matching. The primary outcome was all-cause in-hospital mortality. Three secondary outcomes analyzed include acute kidney injury severity, major morbidity composite, and all-cause 30-day readmissions. RESULTS: In the propensity-score matched cohort, receipt of perioperative 5% albumin was associated with decreased risk of in-hospital mortality (odds ratio [OR], 0.5; 95% confidence interval [CI], 0.3 to 0.9; P = 0.02) and lower all-cause 30-day readmission rates (OR, 0.7; 98.3% CI, 0.5 to 0.9; P < 0.01). Albumin therapy was not associated with differences in overall major morbidity (OR, 0.9; 98.3% CI, 0.7 to 1.2; P = 0.39; composite) or acute kidney injury severity (OR, 0.9; 98.3% CI, 0.6 to 1.4; P = 0.53) compared with therapy with crystalloid solutions. CONCLUSIONS: In this large retrospective study, use of 5% albumin solution was associated with significantly decreased odds of in-hospital mortality and all-cause 30-day readmission rate compared with administration of crystalloids alone in adult patients undergoing on-pump cardiac surgery. These results warrant further studies to examine fluid receipt, including 5% albumin, in surgical populations via randomized-controlled trials.
Authors: Mbakise P Matebele; Mahesh Ramanan; Kelly Thompson; George Cornmell; Rishendran V Naidoo; Kiran Shekar Journal: Crit Care Explor Date: 2020-07-15
Authors: Hanna Vlasov; Tatu Juvonen; Seppo Hiippala; Raili Suojaranta; Markku Peltonen; Alexey Schramko; Kaapo Arvonen; Ulla-Stina Salminen; Ilona Kleine Budde; Tiina Eränen; Maxim Mazanikov; Mihkel Meinberg; Tommi Vähäsilta; Erika Wilkman; Ville Pettilä; Eero Pesonen Journal: Trials Date: 2020-02-28 Impact factor: 2.279