W. Ray Kim, MD
Professor and Chief
Stanford University School of Medicine- Gastroenterology and Hepatology
Disclosure information not submitted.
Karthik. Raghunathan, MD, MPH
Associate Professor of Anesthesiology
Duke University Hospital, United States
Disclosure information not submitted.
.jpg "Greg Martin, MD, MSc, FCCM photo")
Greg Martin, MD, MSc, FCCM
Professor of Medicine
Emory University
Atlanta
Disclosure information not submitted.
E. Anne Davis, PharmD, MS
Associate Director, Global HEOR
Grifols SSNA, United States
Disclosure information not submitted.
Navreet Sindhwani, MD
Global Medical Director, Critical Care
Grifols SSNA, United States
Disclosure information not submitted.
Christopher Blanchette, PhD, MBA
Research Professor
University of North Carolina at Charlotte, United States
Disclosure information not submitted.
Santosh Telang, MS
Senior Consultant
Boston Strategic Partners, Inc, United States
Disclosure information not submitted.
Kunal Lodaya, MD
Principal
Boston Strategic Partners, Inc, United States
Disclosure information not submitted.
Title: Cirrhotic Patients with Greater Baseline Severity of Illness Experience Higher Use of Timely Albumin
Introduction: Decompensated cirrhotic patients experience increased risks of morbidity, mortality, and hospital readmission, thus incurring higher hospital costs and charges, placing significant burdens on healthcare systems. We aimed to assess albumin infusion timing in cirrhotic patients to determine whether there was any variance in illness severity among patients receiving albumin.
Methods: From a de-identified, nationwide chargemaster dataset (Premier), we extracted real-world data on adult inpatients (≥18 years old) with cirrhosis, between January 1, 2016 and June 30, 2019. We used International Classification of Diseases (ICD-10) codes to identify cirrhosis. Baseline medical burden was assessed using the van Walraven (VW) weighting algorithm for Elixhauser Comorbidity Index (ECI). Descriptive statistics were used to compare exposure groups by timing of albumin: ‘timely albumin’ was defined as infusion ≤1 day of hospital admission and ‘non-timely albumin’ was defined as albumin infusion >1 day of admission or no albumin at all. We compared the baseline severity of illness among cirrhotic hospitalizations by albumin infusion timing, using a chi-squared test for mechanical ventilation and vasopressor therapy use and the Wilcoxon-Mann-Whitney test for baseline ECI.
Results: We identified 490,006 hospitalizations with cirrhosis after excluding cases of liver transplants, insufficient/no fluid resuscitation, and missing patient demographics and hospital characteristics data. Baseline ECI was higher in the timely albumin group versus non-timely group (16.5±10.1 vs. 15.5±10.2; p< 0.001). The timely albumin group had higher proportions of mechanical ventilation (15.9% vs. 9.2%; p< 0.001) and vasopressor therapy (28.4% vs. 13.2%; p< 0.001) compared to the non-timely group.
Conclusions: Albumin appears to be reserved for cirrhotic patients with greater disease severity, represented by a higher baseline ECI. Additionally, although causal relationship cannot be determined, proportions of mechanical ventilation and vasopressor therapy use were higher in patients receiving timely albumin. Timely albumin may potentially mitigate any downstream complications as compared to non-timely albumin, especially in certain sub-populations. These data suggest that there is scope for timely albumin use in critically ill patients.