Human albumin administration is associated with increased in-hospital mortality in heart failure with hypoproteinaemia patients: analysis of MIMIC-III Database

Abstract Background: Heart failure (HF) is a growing health problem worldwide, especially in the senior. To overcome diuretic resistance in inpatients with HF and hypoproteinaemia, some doctors administer albumin combined with diuretics, though clinical studies on the use of albumin in patients with HF were rare. We aimed to clarify the effect on mortality of administering human albumin during management of HF inpatient especially with hypoproteinaemia. Methods: We extracted 6094 HF patients from Medical Information Mart for Intensive Care III (MIMIC-III) database. Receiver operating characteristic (ROC) curve was used to elucidate the relationship between serum albumin content and in-hospital mortality. Multivariate logistic regression models，propensity score matching (PSM) and lowess smoother curve were employed to analyze the relationship between albumin administration and clinical outcomes. The clinical outcomes contained in-hospital mortality, output at 24-hour, ICU length of stay (LOS) and hospital LOS. In addition, Kaplan-Meier (KM) curve was used to assess 90-day survival in albumin administration and non-albumin administration subgroups before and after PSM. Results: Patients with heart failure, serum albumin concentration is negatively correlated with risk of in-hospital death. Based on ROC curve, the optimal cut-off value for predicting the mortality were 2.9g/dl (area under curve (AUC)= 0.643). Albumin administration was significantly associated with increased mortality during hospitalization in the HF plus serum albumin≤2.9g/dl group (p2.9g/dl group (p= 0.25). After PSM in serum albumin≤2.9g/dl group, hospital LOS and ICU LOS were prolonged (p<0.001, p<0.001), output at 24-hour had no association with albumin infusion (p= 0.229), 90-day mortality was no significant difference between albumin administration and non-albumin administration patients with albumin≤2.9g/dl after PSM (p= 0.12). Conclusion: Albumin administration was associated with increased risk of in-hospital mortality, as well as longer hospital LOS and ICU LOS among HF patients with hypoproteinaemia.