Dataset Information

Impact of albumin infusion on prognosis of intensive care unit patients with congestive heart failure-hypoalbuminemia overlap: a retrospective cohort study.

ABSTRACT:

Background

Hypoalbuminemia is common in congestive heart failure (CHF) patients. Serum albumin is associated with the prognosis of CHF patients. Impact of albumin infusion on prognosis of patients with CHF-hypoalbuminemia overlap remains unclear. We retrospectively investigated the impact of albumin infusion on prognosis of intensive care unit (ICU) patients with CHF-hypoalbuminemia overlap.

Methods

We enrolled all patients whose diagnosis included CHF [ICD-9 (international classification of diseases 9) code =428.0] at first ICU admission from the MIMIC III (Medical Information Mart for Intensive Care III) database, and excluded those with missing serum albumin values, with serum albumin >3.4 g/dL or <18 years old. According to the exposure of albumin infusion during hospitalization, patients were stratified into non-albumin and albumin groups. Propensity-score matching (PSM) was performed (1:1 ratio) to control for baseline confounding. Outcome measures were in-hospital mortality as well as length of stay in the ICU (ICU LOS) and the hospital (hospital LOS).

Results

There were 3,190 eligible patients in the initial search. Patients with albumin infusion had markedly higher in-hospital mortality (36.42% vs. 21.81%, P<0.001), longer ICU LOS [median 6.93 (3.39-14.82) vs. 3.84 (1.96-8.00) days, P<0.001], and longer hospital LOS [median 17.46 (11.45-28.33) vs. 10.92 (6.81-18.00) days, P<0.001] than those without albumin infusion. The multivariate logistic regression analysis revealed that albumin infusion [odds ratio (OR), 1.509; 95% confidence interval (CI), 1.164-1.957; P=0.002] was significantly associated with increased risk of in-hospital mortality. After PSM, a cohort of 429 pairs of patients was included in the final analysis. Patients with albumin infusion had markedly higher in-hospital mortality (34.97% vs. 27.27%, P=0.015), longer ICU LOS [median 8.43 (4.33-16.28) vs. 6.43 (3.07-13.66) days, P<0.001], and longer hospital LOS [median 16.92 (11.27-28.06) vs. 13.33 (8.00-21.10) days, P<0.001] than those without albumin infusion. The multivariate logistic regression analysis revealed that albumin infusion (OR, 1.594; 95% CI, 1.143-2.223; P=0.006) was significantly associated with increased risk of in-hospital mortality.

Conclusions

Albumin infusion increased in-hospital mortality, ICU LOS, and hospital LOS in ICU patients with CHF-hypoalbuminemia overlap.

SUBMITTER: Li Z

PROVIDER: S-EPMC9264072 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Impact of albumin infusion on prognosis of intensive care unit patients with congestive heart failure-hypoalbuminemia overlap: a retrospective cohort study.

Li Zexiong Z Ling Yesheng Y Yuan Xiaosi X Liu Xiao X Huang Weipeng W Chen Qian Q Wang Jiafu J Chen Yangbo Y Xu Mingwei M Wu Bingyuan B

Journal of thoracic disease 20220601 6

<h4>Background</h4>Hypoalbuminemia is common in congestive heart failure (CHF) patients. Serum albumin is associated with the prognosis of CHF patients. Impact of albumin infusion on prognosis of patients with CHF-hypoalbuminemia overlap remains unclear. We retrospectively investigated the impact of albumin infusion on prognosis of intensive care unit (ICU) patients with CHF-hypoalbuminemia overlap.<h4>Methods</h4>We enrolled all patients whose diagnosis included CHF [ICD-9 (international classi ...[more]

PMID: 35813730

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Project description:BackgroundAt present, the relationship between severe acute pancreatitis (SAP) and albumin infusion is not clear. We aimed to identify the impact of serum albumin on the prognosis of SAP and the association between albumin infusions and mortality for hypoalbuminemia patients.MethodsThis was a retrospective cohort study that analyzed 1000 patients with SAP who were admitted to the First Affiliated Hospital of Nanchang University between January 2010 and December 2021 using data from a prospectively maintained database. Multivariate logistic regression analysis was conducted to reveal the relationship between serum albumin within 1 week after admission and poor prognosis of SAP. Propensity score matching (PSM) analysis was adopted to evaluate the effect of albumin infusion for hypoalbuminemia patients with SAP.ResultsThe prevalence of hypoalbuminemia (≤ 30 g/L) was 56.9% within 1 week after admission. Multivariate logistic regression identified that age (OR: 1.02; 95% CI: 1.00-1.04; P = 0.012), serum urea (OR: 1.08; 95% CI: 1.04-1.12; P < 0.001), serum calcium (OR: 0.27; 95% CI: 0.14-0.50; P < 0.001), lowest albumin level within 1 week after admission (OR: 0.93; 95% CI: 0.89-0.97; P = 0.002), and APACHE II score ≥ 15 (OR: 1.73; 95% CI: 1.19-2.51; P = 0.004) were independently associated with mortality. The PSM analysis demonstrated that mortality (OR: 0.52, 95% CI: 0.29-0.92, P = 0.023) was less common in albumin-infused than non-albumin-infused hypoalbuminemia patients. In subgroup analyses, doses > 100 g within 1 week after admission for hypoalbuminemia patients with albumin infusions was associated with lower mortality than doses ≤ 100 g (OR: 0.51, 95% CI: 0.28-0.90, P = 0.020).ConclusionsHypoalbuminemia in early-stage SAP is significantly related to poor prognosis. However, albumin infusions could significantly decrease mortality in hypoalbuminemia patients with SAP. Additionally, infusing sufficient albumin within a week after admission may decrease mortality in hypoalbuminemia patients.

Project description:Objective Congestive heart failure (CHF) is a clinical syndrome in which the heart disease progresses to a severe stage. Early diagnosis and risk assessment of death of patients with CHF are critical to prognosis and treatment. The purpose of this study was to establish a nomogram that predicts the in-hospital death of patients with CHF in the intensive care unit (ICU). Design A retrospective observational cohort study. Setting and participants Data for the study were from 30 411 patients with CHF in the Medical Information Mart for Intensive Care database and the eICU Collaborative Research Database (eICU-CRD). Primary outcome In-hospital mortality. Methods Univariate logistic regression analysis was used to select risk factors associated with in-hospital mortality of patients with CHF, and multivariate logistic regression was used to build the prediction model. Discrimination, calibration and clinical validity of the model were evaluated by AUC, calibration curve, Hosmer-Lemeshow χ2 test and decision curve analysis, respectively. Finally, data from 15 503 patients with CHF in the multicentre eICU-CRD were used for external validation of the established nomogram. Results The inclusion criteria were met by 15 983 subjects, whose in-hospital mortality rate was 12.4%. Multivariate analysis determined that the independent risk factors were age, race, norepinephrine, dopamine, phenylephrine, vasopressin, mechanical ventilation, intubation, hepatic failure (HepF), heart rate, respiratory rate, temperature, systolic blood pressure (SBP), anion gap (AG), blood urea nitrogen (BUN), creatinine, chloride, mean corpuscular volume (MCV), red blood cell distribution width (RDW) and white cell count (WCC). The C-index of the nomogram (0.767, 95% CI 0.759 to 0.779) was superior to that of the traditional Sequential Organ Failure Assessment, Acute Physiology Score III and Get With The Guidelines Heart Failure scores, indicating its discrimination power. Calibration plots demonstrated that the predicted results are in good agreement with the observed results. The decision curves of the derivation and validation sets both had net benefits. Conclusion The 20 independent risk factors for in-hospital mortality of patients with CHF were age, race, norepinephrine, dopamine, phenylephrine, vasopressin, mechanical ventilation, intubation, HepF, heart rate, respiratory rate, temperature, SBP, AG, BUN, creatinine, chloride, MCV, RDW and WCC. The nomogram, which included these factors, accurately predicted the in-hospital mortality of patients with CHF. The novel nomogram has the potential for use in clinical practice as a tool to predict and assess mortality of patients with CHF in the ICU.

Project description:BackgroundCongestive heart failure (HF) is a common condition in the intensive care unit (ICU). Cardiomyopathy is an important etiological factor in HF. However, few studies have explored the effect of cardiomyopathy on the prognosis of HF. This study explored the association between comorbid cardiomyopathy and the outcomes of critically ill patients with congestive HF.MethodsA retrospective cohort study was performed using data extracted from Medical Information Mart for Intensive Care IV (MIMIC-IV) database. All adult patients with the first ICU admission were enrolled as participants but those diagnosed with cardiomyopathy alone were excluded. The demographics, comorbidities, vital signs, laboratory tests, scoring systems, and treatments of patients were extracted to further analyze. The composite endpoints included in-hospital mortality, cardiac arrest, and re-admission to the ICU. The association between cardiomyopathy comorbidity and the composite endpoints was assessed using propensity-score matching (PSM) and multivariable logistic regression models.ResultsA total of 27,901 critically ill patients were enrolled, including 1,023 patients diagnosed with cardiomyopathy and congestive HF. The average age of the cohort was 64.37±17.36 years, and 58.13% of the patients were men. The ethnicity of patients was mainly white (64.67%). Multivariable logistic regression analyses found the risk of composite endpoints in patients with cardiomyopathy was higher than other groups [odds ratio (OR) =1.87; 95% confidence interval (CI): 1.62-2.15; P<0.001]. Compared to patients with congestive HF alone (OR =1.43; 95% CI: 1.26-1.62; P<0.001), patients with cardiomyopathy had a similar risk of in-hospital death (OR =1.35; 95% CI: 1.06-1.71; P=0.014). Moreover, the risks of cardiac arrest (OR =1.53; 95% CI: 1.01-2.34; P=0.029) and re-admission to the ICU (OR =1.74; 95% CI: 1.39-2.17; P<0.001) were both higher in patients with cardiomyopathy than other groups. After PSM, the risk of composite endpoints was still higher in patients with cardiomyopathy (OR =1.64; 95% CI: 1.33-2.02; P<0.001). The association was consistent among patients admitted to the coronary care unit (CCU) and medical ICU (MICU)/surgical ICU (SICU).ConclusionsComorbid cardiomyopathy increased the risk of composite endpoints in patients with congestive HF admitted to the ICU. Cardiomyopathy is related to the poor outcomes of critically ill patients with congestive HF.

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Dataset Information

Impact of albumin infusion on prognosis of intensive care unit patients with congestive heart failure-hypoalbuminemia overlap: a retrospective cohort study.

Background

Methods

Results

Conclusions

Publications

Impact of albumin infusion on prognosis of intensive care unit patients with congestive heart failure-hypoalbuminemia overlap: a retrospective cohort study.

Similar Datasets

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