Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, Indiana, USA.
Liver Int. 2022 Jan;42(1):187-198. doi: 10.1111/liv.15096. Epub 2021 Nov 22.
BACKGROUND & AIMS: Guidelines recommend albumin as the plasma-expander of choice for acute kidney injury (AKI) in cirrhosis. However, the impact of these recommendations on patient outcomes remains unclear. We aimed to determine the practice-patterns and outcomes associated with albumin use in a large, nationwide-US cohort of hospitalized cirrhotics with AKI.
A retrospective cohort study was performed in hospitalized cirrhotics with AKI using Cerner-Health-Facts database from January 2009 to March 2018. 6786 were included for analysis on albumin-practice-patterns, and 4126 had available outcomes data. Propensity-score-adjusted model was used to determine the association between albumin use, AKI-recovery and in-hospital survival.
Median age was 61-years (60% male, 70% white), median serum-creatinine was 1.8 mg/dL and median Model for End-stage Liver Disease Sodium (MELD-Na) score was 24. Albumin was given to 35% of patients, of which 50% received albumin within 48-hours of AKI-onset, and 17% received appropriate weight-based dosing. Albumin was used more frequently in patients with advanced complications of cirrhosis, higher MELD-Na scores and patients admitted to urban-teaching hospitals. After propensity-matching and multivariable adjustment, albumin use was not associated with AKI-recovery (odds ratio [OR] 0.70, 95% confidence-interval [CI]: 0.59-1.07, P = .130) or in-hospital survival (OR 0.76 [95% CI: 0.46-1.25], P = .280), compared with crystalloids. Findings were unchanged in subgroup analyses of patients with varying cirrhosis complications and disease severity.
USA hospitalized patients with cirrhosis and AKI frequently do not receive intravenous albumin, and albumin use was not associated with improved clinical outcomes. Prospective randomised trials are direly needed to evaluate the impact of albumin in cirrhotics with AKI.
指南建议将白蛋白作为肝硬化急性肾损伤（AKI）的首选血浆扩容剂。然而，这些建议对患者结局的影响仍不清楚。我们旨在通过一项来自美国全国范围内的大型住院肝硬化 AKI 患者队列研究，确定白蛋白使用的实践模式和结局。
利用 Cerner-Health-Facts 数据库，对 2009 年 1 月至 2018 年 3 月住院的肝硬化 AKI 患者进行回顾性队列研究。纳入 6786 例患者进行白蛋白使用实践模式分析，4126 例患者有可用结局数据。采用倾向评分调整模型，确定白蛋白使用与 AKI 恢复和院内生存率之间的关系。
中位年龄为 61 岁（60%为男性，70%为白人），中位血清肌酐为 1.8mg/dL，中位终末期肝病模型钠（MELD-Na）评分为 24 分。35%的患者接受了白蛋白治疗，其中 50%在 AKI 发病后 48 小时内接受白蛋白治疗，17%接受了适当的基于体重的剂量。在有晚期肝硬化并发症、更高 MELD-Na 评分和入住城市教学医院的患者中，白蛋白的使用更为频繁。在倾向匹配和多变量调整后，与晶体液相比，白蛋白的使用与 AKI 恢复（比值比 [OR]0.70，95%置信区间 [CI]：0.59-1.07，P=0.130）或院内生存率（OR0.76 [95% CI：0.46-1.25]，P=0.280）无关。在不同肝硬化并发症和疾病严重程度的患者亚组分析中，结果不变。
美国住院肝硬化 AKI 患者经常不接受静脉内白蛋白治疗，白蛋白的使用与改善临床结局无关。迫切需要前瞻性随机试验来评估白蛋白在肝硬化 AKI 患者中的作用。
