Introduction: Septic shock is a life-threatening condition with high ICU mortality. Hypoalbuminemia is common and linked to poor prognosis. Although albumin infusion may offer physiological benefits, its clinical efficacy remains uncertain. This study explores the impact of albumin infusion strategies on 28-day mortality using MIMIC-IV and real-world ICU data. Methods: This retrospective cohort study analyzed data from the MIMIC-IV database and the university-affiliated teaching hospital ICU. Patients with septic shock and hypoalbuminemia were categorized into early albumin infusion (within 72 hours of ICU admission) and late albumin infusion (after 72 hours of ICU admission), regardless of dosage or colloid osmotic pressure. The primary outcome measured was the 28-day mortality rate. Propensity score matching (PSM) and multivariate logistic regression analyses were performed to adjust for baseline differences and identify independent risk factors associated with mortality. Results: In the MIMIC-IV cohort (n = 3,401), 1,216 patients received albumin infusion, including 546 with early infusion (within 72 hours of ICU admission) and 670 with late infusion. Early albumin infusion was associated with significantly higher 28-day mortality compared to late or no infusion. Subgroup analysis showed a survival benefit in patients with severe hypoalbuminaemia (serum albumin < 20 g/L), but worse outcomes in those with mild-to-moderate hypoalbuminaemia (20–35 g/L). These findings were partially validated in an independent cohort from Sun Yat-sen Memorial Hospital (n = 1,233), where similar trends were observed. Early infusion was associated with increased mortality, and albumin use in mild-to-moderate hypoalbuminaemia was linked to worse survival. No significant benefit was observed in patients with severe hypoalbuminaemia. Conclusions: In conclusion, early albumin infusion for patients with septic shock did not demonstrate a clear clinical benefit regarding 28-day mortality. Late infusion, however, appeared to be associated with improved survival outcomes. Among patients with septic shock and severe hypoalbuminemia, albumin infusion was associated with significantly improve 28-day survival. In contrast, for those with mild-to-moderate hypoalbuminemia, albumin infusion did not offer a significant survival advantage.
Lin et al. (Sun,) studied this question.