Study of the Effectiveness of Albumin Replacement in Ventilated Patients with Hypoalbuminemia at Phrae Hospital

Abstract

Background: Hypoalbuminemia can lead to acute respiratory failure and increased mortality. Various types of fluid resuscitation are used in critically ill patients, depending on their condition, and albumin is one of them. However, previous studies on albumin use in mechanically ventilated patients with hypoalbuminemia remain controversial.

Objective: To study the association between 28-day in-hospital mortality, ventilator-free days within 28 days, and hospitalization duration in ventilated patients with hypoalbuminemia, comparing those who received albumin replacement with those who did not.

Methods: This single-center retrospective cohort study included 443 mechanically ventilated patients with hypoalbuminemia (serum albumin < 2.5 g/dL) due to septic shock, pneumonia, or acute respiratory distress syndrome (ARDS), admitted to Phrae Hospital, Thailand, from January 1 to December 31, 2023. Patients either received 20% albumin or did not receive albumin. Primary outcomes were analyzed using modified Poisson regression with robust standard errors (SEs) to estimate relative risks (RRs, 95% CI). Covariates were selected from univariable logistic regression (p-value < 0.05) and directed acyclic graphs (DAGs) before fitting the final model; interaction terms were tested and multicollinearity was assessed (VIF < 5). Secondary outcomes were compared using t-tests or Wilcoxon rank sum tests.

Results: Within 28 days, 129 of 225 patients (57.33%) in the albumin group and 84 of 218 patients (38.53%) in the non-albumin group had died (RR = 1.34; 95% CI: 1.09–1.65, p-value = 0.006). No statistically significant differences were observed in subgroup analyses of patients with serum albumin < 1.5 g/dL, 1.6–2.0 g/dL or SOFA score ≥ 6. However, among patients aged < 40 years in the albumin group was associated with a significantly reduced mortality rate. For secondary outcomes, ventilator-free days within 28 days were significantly lower in the albumin group (p-value < 0.001), while hospital length of stay was significantly longer compared to the non-albumin group (p-value < 0.001).

Conclusions: In mechanically ventilated patients with septic shock, pneumonia, or ARDS and hypoalbuminemia, albumin replacement, compared with no albumin use, did not improve 28-day survival.