What question did this study set out to answer?

To assess the relationship between serum albumin levels and prolonged intensive care unit length of stay in patients with acute heart failure.

February 24, 2023PLoS ONEOpen Access

The association between serum albumin and long length of stay of patients with acute heart failure: A retrospective study based on the MIMIC-IV database

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Why the study?

The study was conducted to evaluate the relationship between serum albumin level and long length of stay among intensive care unit inpatients with acute heart failure.

Does higher serum albumin level reduce the risk of long length of stay in the ICU in patients with acute heart failure?

Key Points

To assess the relationship between serum albumin levels and prolonged intensive care unit length of stay in patients with acute heart failure.
Retrospective analysis of N=2,280 patients with acute heart failure extracted from the MIMIC-IV database.
Multivariate logistic regression was utilized to assess independent predictors of long length of stay and to construct a predictive nomogram.
Serum albumin demonstrated a significant negative linear relationship with prolonged ICU stay (P for trend <0.001; AUC 0.649, 95% CI 0.616–0.683, P <0.001) and was independently protective (OR 0.559, 95% CI 0.450–0.695, P <0.001).
Other independent risk factors for prolonged stay included respiratory failure (OR 1.672, 95% CI 1.289–2.169, P <0.001), lactic acid (OR 1.269, 95% CI 1.167–1.381, P <0.001), creatinine (OR 1.221, 95% CI 1.098–1.257, P <0.001), WBC (OR 1.046, 95% CI 1.031–1.061, P <0.001), and glucose (OR 1.010, 95% CI 1.007–1.012, P <0.001).
A clinical nomogram incorporating these independent predictors accurately forecasted prolonged ICU stays with an AUC of 0.740 (95% CI 0.712–0.768, P <0.001) and demonstrated good calibration and clinical applicability.

Structured PICO

Does higher serum albumin level reduce the risk of long length of stay in the ICU in patients with acute heart failure?

Population

2,280 adults (age >18 years) with acute heart failure (AHF) admitted to the intensive care unit (ICU) from the MIMIC-IV database, mean age 69.88, 56.80% male.

Intervention

Serum albumin level at the time of admission to ICU (evaluated as a continuous variable and in quartiles)

Comparator

Lower quartiles of serum albumin (Q1: 1.6-3.0 g/dL) compared to higher quartiles

Outcome

Long length of stay (LOS) in the ICU, defined as more than 7 days

Higher serum albumin levels at ICU admission are independently associated with a reduced risk of prolonged ICU stay (>7 days) in patients with acute heart failure.

Limitations

Maximum serum albumin level included was 5.1 g/dl
No external verification of the predictive model
Might not have adjusted for other potential confounding factors

Implication

Lower albumin was associated with longer LOS in AHF; hypothesis-generating and requires prospective validation before guiding care or models.

Abstract

BACKGROUND: The purpose of this article is to assess the relationship between serum albumin level and long length of stay (LOS) of inpatients with acute heart failure (AHF) in the intensive care unit (ICU). METHODS: We retrospectively analyzed data of 2280 patients with AHF from the medical information mart for intensive care IV (the MIMIC-IV) database. Multivariate logistic regression was performed to evaluate the association between serum albumin and long LOS, and the development of the predictive model was based on independent predictors of long LOS. RESULTS: According to the statistical results, A negative linear relationship was presented between albumin and long LOS of AHF patients in the ICU (P for trend <0.001), and serum albumin could predict long LOS (AUC 0.649, 95%CI 0.616-0.683, P <0.001). Based on independent predictors, including respiratory failure (OR 1.672, 95%CI 1.289-2.169, P<0.001), WBC (OR 1.046, 95%CI 1.031-1.061, P<0.001), creatinine (OR 1.221, 95%CI 1.098-1.257, P<0.001), glucose (OR 1.010, 95%CI 1.007-1.012, P<0.001), lactic acid (OR 1.269, 95%CI 1.167-1.381, P<0.001), and albumin (OR 0.559, 95%CI 0.450-0.695, P<0.001), identified by multivariable logistic regression analysis, we developed the nomogram to predict the probability of long LOS of AHF patients in the ICU. The nomogram accurately predicted the probability of long LOS (AUC 0.740, 95%CI 0.712-0.768, P<0.001). The calibration suggested the predictive probability was highly consistent with the actual probability of long LOS. Decision curve analysis (DCA) also suggested that the nomogram was applicable in the clinic. CONCLUSION: Serum albumin level was negatively associated with LOS among AHF patients. The predictive model based on serum albumin has predictive value for evaluating the length of stay in AHF patients.