Intravenous albumin for initial resuscitation and mortality in septic shock patients: propensity score analyses using a nationwide inpatient database

Abstract

BACKGROUND

A recent large randomized controlled study suggested that albumin administration may reduce mortality in patients with septic shock. However, it remains unclear whether albumin should be used for initial resuscitation only without subsequent supplementation. The present study aimed to assess whether intravenous albumin infusion for initial resuscitation without subsequent supplementation is associated with reduced mortality in patients with septic shock using a national inpatient administrative claims database.

METHODS

In this retrospective cohort study using the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2016, we identified patients with septic shock who received ≥3000 mL of total fluids on day 1 after the start of noradrenaline. We defined patients who received ≥75 g of albumin within 2 days after the start of noradrenaline as the albumin group and other patients as the control group. We performed one-to-one propensity-score matching analyses to analyze the associations of albumin administration with 28-day and 90-day mortality.

RESULTS

We identified 85,563 eligible patients during the 69-month study period. Of these, 6888 patients (8.1%) were allocated to the albumin group. After propensity-score matching, no significant differences were seen between the two groups for 28-day mortality (relative risk 0.95, 95% confidence interval 0.88–1.02) and 90-day mortality (relative risk 0.97, 95% confidence interval 0.92–1.03).

CONCLUSIONS

Intravenous albumin for initial resuscitation without subsequent supplementation was not significantly associated with reduced short-term mortality in patients with septic shock. Intravenous albumin for initial resuscitation only may therefore be ineffective.