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
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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: Timely Albumin Infusion May Improve Survival in Cirrhotic Patients: A U.S. Cross-Sectional Study
Introduction: Cirrhosis is the end stage of any condition in which the liver progressively becomes scarred. It is a common cause of increased risks of morbidity, mortality, and hospital readmission. Albumin plays a critical role in the management of decompensated cirrhosis and end-stage liver disease. Using real-world evidence from a multi-hospital U.S health database, we assessed the association between albumin infusion timing and in-hospital mortality among cirrhotic patients.
Methods: We utilized a de-identified, nationwide chargemaster dataset (Premier) and extracted information on adult patients (≥18 years old) hospitalized with cirrhosis, between January 1, 2016 and June 30, 2019. We defined baseline Elixhauser Comorbidity Index (ECI) using van Walraven weighting algorithm. Our exposure groups were: ‘timely albumin’ defined as infusion ≤1 day of hospital admission and ‘non-timely albumin’ defined as infusion >1 day of admission or no albumin at all. Logistic regression models were used to determine the association between timely albumin and in-hospital mortality after 1:1 propensity score matching (PSM); adjusting for patient and hospital characteristics, ECI, and presence of hepatorenal syndrome, end-stage renal disease, and ascites at baseline.
Results: The initial selection criteria identified 921,692 adult inpatient hospitalizations. Out of these, 490,006 remained after excluding for missing hospital/patient data, liver transplant, and insufficient or no fluid resuscitation. After 1:1 matching, a total of 109,674 inpatient hospitalizations were analyzed. A risk-adjusted analysis showed the timely albumin group to be associated with a 16% reduction in in-hospital mortality when compared to the non-timely group (OR: 0.84; 95% CI: 0.81 -0.89; p< 0.001).
Conclusions: Timely albumin in cirrhotic patients was associated with lower in-hospital mortality. These data suggest that timely albumin use in cirrhosis, as per general guideline recommendations, may improve health outcomes. Albumin may be administered to a wider patient population for potentially greater benefits, rather than reserving it only for worsened prognoses due to perceived higher costs.