Li Zexiong, Ling Yesheng, Yuan Xiaosi, Liu Xiao, Huang Weipeng, Chen Qian, Wang Jiafu, Chen Yangbo, Xu Mingwei, Wu Bingyuan
Department of Cardiovascular Medicine, Jieyang People's Hospital, Jieyang, China.
Department of Cardiovascular Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
J Thorac Dis. 2022 Jun;14(6):2235-2246. doi: 10.21037/jtd-22-648.
Hypoalbuminemia is common in congestive heart failure (CHF) patients. Serum albumin is associated with the prognosis of CHF patients. Impact of albumin infusion on prognosis of patients with CHF-hypoalbuminemia overlap remains unclear. We retrospectively investigated the impact of albumin infusion on prognosis of intensive care unit (ICU) patients with CHF-hypoalbuminemia overlap.
We enrolled all patients whose diagnosis included CHF [ICD-9 (international classification of diseases 9) code =428.0] at first ICU admission from the MIMIC III (Medical Information Mart for Intensive Care III) database, and excluded those with missing serum albumin values, with serum albumin >3.4 g/dL or <18 years old. According to the exposure of albumin infusion during hospitalization, patients were stratified into non-albumin and albumin groups. Propensity-score matching (PSM) was performed (1:1 ratio) to control for baseline confounding. Outcome measures were in-hospital mortality as well as length of stay in the ICU (ICU LOS) and the hospital (hospital LOS).
There were 3,190 eligible patients in the initial search. Patients with albumin infusion had markedly higher in-hospital mortality (36.42% 21.81%, P<0.001), longer ICU LOS [median 6.93 (3.39-14.82) 3.84 (1.96-8.00) days, P<0.001], and longer hospital LOS [median 17.46 (11.45-28.33) 10.92 (6.81-18.00) days, P<0.001] than those without albumin infusion. The multivariate logistic regression analysis revealed that albumin infusion [odds ratio (OR), 1.509; 95% confidence interval (CI), 1.164-1.957; P=0.002] was significantly associated with increased risk of in-hospital mortality. After PSM, a cohort of 429 pairs of patients was included in the final analysis. Patients with albumin infusion had markedly higher in-hospital mortality (34.97% 27.27%, P=0.015), longer ICU LOS [median 8.43 (4.33-16.28) 6.43 (3.07-13.66) days, P<0.001], and longer hospital LOS [median 16.92 (11.27-28.06) 13.33 (8.00-21.10) days, P<0.001] than those without albumin infusion. The multivariate logistic regression analysis revealed that albumin infusion (OR, 1.594; 95% CI, 1.143-2.223; P=0.006) was significantly associated with increased risk of in-hospital mortality.
Albumin infusion increased in-hospital mortality, ICU LOS, and hospital LOS in ICU patients with CHF-hypoalbuminemia overlap.
低白蛋白血症在充血性心力衰竭（CHF）患者中很常见。血清白蛋白与CHF患者的预后相关。白蛋白输注对CHF合并低白蛋白血症患者预后的影响尚不清楚。我们回顾性研究了白蛋白输注对重症监护病房（ICU）中CHF合并低白蛋白血症患者预后的影响。
我们从MIMIC III（重症监护医学信息数据库III）数据库中纳入了所有首次入住ICU时诊断包括CHF[国际疾病分类第9版（ICD-9）编码=428.0]的患者，并排除了血清白蛋白值缺失、血清白蛋白>3.4 g/dL或年龄<18岁的患者。根据住院期间白蛋白输注情况，将患者分为非白蛋白组和白蛋白组。进行倾向评分匹配（PSM）（1:1比例）以控制基线混杂因素。观察指标为住院死亡率以及在ICU的住院时间（ICU住院时间）和在医院的住院时间（医院住院时间）。
初步检索中有3190例符合条件的患者。接受白蛋白输注的患者住院死亡率明显更高（36.42%对21.81%，P<0.001），ICU住院时间更长[中位数6.93（3.39 - 14.82）天对3.84（1.96 - 8.00）天，P<0.001]，医院住院时间也更长[中位数17.46（11.45 - 28.33）天对10.92（6.81 - 18.00）天，P<0.001]，高于未接受白蛋白输注的患者。多因素逻辑回归分析显示，白蛋白输注[比值比（OR），1.509；95%置信区间（CI），1.164 - 1.957；P = 0.002]与住院死亡风险增加显著相关。PSM后，最终分析纳入了429对患者。接受白蛋白输注的患者住院死亡率明显更高（34.97%对27.27%，P = 0.015），ICU住院时间更长[中位数8.43（4.33 - 16.28）天对6.43（3.07 - 13.66）天，P<0.001]，医院住院时间也更长[中位数16.92（11.27 - 28.06）天对13.33（8.00 - 21.10）天，P<0.001]，高于未接受白蛋白输注的患者。多因素逻辑回归分析显示，白蛋白输注（OR，1.594；95%CI，1.143 - 2.223；P = 0.006）与住院死亡风险增加显著相关。
白蛋白输注增加了CHF合并低白蛋白血症的ICU患者的住院死亡率、ICU住院时间和医院住院时间。
