Clinical and economic outcomes associated with intravenous albumin fluid use in the intensive care unit: a retrospective cohort study

ABSTRACT

Objectives

This study was undertaken to evaluate the prescribing practice of albumin in the intensive care unit (ICU) and to compare the clinical and economic outcomes associated with intravenous (IV) albumin compared to crystalloids in the ICU.

Methods

This was a retrospective cohort study of ICU adult patients admitted to King Abdullah University Hospital during 2018–2019. Patient demographics, clinical characteristics, and admission charges were retrieved from medical records and billing system. Survival analysis, multivariable regression models, and propensity score matching estimator were performed to evaluate the impact of IV resuscitation fluid types on the clinical and economic outcomes.

Results

Albumin administration in the ICU was associated with significantly lower hazards of ICU death (HR = 0.57; P value <0.001), but without improving overall death probability compared to crystalloids. Albumin was associated with significant prolongation in the ICU length of stay (5.86 days; P value <0.001). Only 88 patients (24.3%) were prescribed albumin for Food and Drug Administration (FDA)-approved indications. Admission charges were significantly higher for patients treated with albumin (p value <0.001).

Conclusions

IV Albumin use in the ICU was not associated with significant improvement in clinical outcomes, but with a remarkable increase in economic burden. The majority of patients received albumin for non-FDA-approved indications.

KEYWORDS:

• Intensive Care Unit
• Intravenous fluid
• Albumin
• Crystalloids
• Mortality
• Charges

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

S Altawalbeh, E Almestarihi: Conceptualization, Methodology, Data curation, Formal analysis, Supervision, Project administration, Funding acquisition, Writing – Original draft preparation, Writing – Reviewing and Editing. S Momany, and R Khasawneh: Conceptualization, Methodology, Writing – Original draft preparation, and Writing – Reviewing and Editing. M Ababneh and M Shawaqfeh: Methodology, Writing – Original draft preparation, and Writing – Reviewing and Editing. All authors approved the final manuscript for publication.

Data availability statement

The data for this study are available upon reasonable request from the corresponding author.

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2023.2215431

Additional information

Funding

This work was supported by the Deanship of Scientific Research at Jordan University of Science and Technology [grant number: 20210314, 2021]. The funding agency was not involved in the study design, conduct, writing or decision to submit the article for publication