Raghunathan Karthik, Kempker Jordan A, Davis E Anne, Sindhwani Navreet S, Telang Santosh, Lodaya Kunal, Martin Greg S
Department of Anesthesiology, Duke University, Durham, NC.
Department of Medicine, Emory University, Atlanta, GA.
Crit Care Explor. 2022 Dec 12;4(12):e0793. doi: 10.1097/CCE.0000000000000793. eCollection 2022 Dec.
Adults hospitalized with sepsis/septic shock commonly develop acute kidney injury (AKI) which imposes a significant burden on the healthcare system. The administration of early human albumin in this patient population may yield more efficient healthcare resource utilization.
To examine the association between early use of albumin and time to discharge in adults who develop severe AKI while hospitalized with sepsis/septic shock.
Retrospective cohort study using de-identified electronic health records from a national database (Cerner Health Facts; Cerner Corp., Kansas City, MO).
Patients ( = 2,829) hospitalized between January 2013 and April 2018 with a diagnosis of sepsis/septic shock (identified using , 9th Revision and 10th Revision codes) who developed severe AKI (stage 3 according to Kidney Disease Improving Global Outcomes criteria) during hospitalization ( = 2,845 unique encounters).
Patients were grouped according to timing of albumin exposure: within less than or equal to 24 hours of admission ("early albumin") or unexposed/exposed late ("nonearly albumin"). A cause-specific hazard model, censoring for death/discharge to hospice, was used to examine the association between "early albumin" and the rate of hospital discharge with clinical stability.
Albumin was administered early in 8.6% of cases. Cases with early albumin administration had a median time to discharge of 13.2 days compared with 17.0 in the nonearly group (Log-rank < 0.0001). An adjusted analysis showed that the rate of hospital discharge with clinical stability increased by 83% in the early albumin group compared with the nonearly group (hazard ratio, 1.832; 95% CI, 1.564-2.146; < 0.001 nonearly group.
The use of albumin within 24 hours of hospital admission was associated with a shorter time to discharge and a higher rate of discharge with clinical stability, suggesting an improvement in healthcare resource utilization among patients with sepsis/septic shock who developed stage 3 AKI during hospitalization.
因脓毒症/脓毒性休克住院的成年人常发生急性肾损伤（AKI），这给医疗系统带来了沉重负担。在此类患者群体中早期使用人白蛋白可能会提高医疗资源的利用效率。
研究在因脓毒症/脓毒性休克住院期间发生严重急性肾损伤的成年人中，早期使用白蛋白与出院时间之间的关联。
使用来自国家数据库（Cerner Health Facts；Cerner公司，密苏里州堪萨斯城）的去识别化电子健康记录进行回顾性队列研究。
2013年1月至2018年4月期间因脓毒症/脓毒性休克诊断（使用国际疾病分类第9版和第10版编码识别）住院且在住院期间发生严重急性肾损伤（根据改善全球肾脏病预后标准为3期）的患者（n = 2,829）（n = 2,845次独特就诊）。
根据白蛋白暴露时间对患者进行分组：入院后24小时内（“早期白蛋白”）或未暴露/晚期暴露（“非早期白蛋白”）。使用特定病因风险模型，对死亡/转至临终关怀进行截尾，以研究“早期白蛋白”与临床稳定出院率之间的关联。
8.6%的病例早期使用了白蛋白。早期使用白蛋白的病例出院中位时间为13.2天，而非早期组为17.0天（对数秩检验P < 0.0001）。校正分析显示，与非早期组相比，早期白蛋白组临床稳定出院率提高了83%（风险比，1.832；95%可信区间，1.564 - 2.146；非早期组P < 0.001）。
入院24小时内使用白蛋白与出院时间缩短及临床稳定出院率提高相关联，这表明在住院期间发生3期急性肾损伤的脓毒症/脓毒性休克患者中，医疗资源利用得到了改善。
