Albumin use and mortality among intensive care patients with acute heart failure: a retrospective study

Hypoproteinemia is common in patients with acute heart failure, especially in the intensive care unit (ICU). We assessed short-term mortality in patients with acute heart failure for albumin and nonalbumin users.

Our study was a retrospective, observational and single-center study. We included patients with acute heart failure from the Medical Information Mart for Intensive Care-IV and compared short-term mortality and length of hospital stay in patients with and without albumin use. We used propensity score matching (PSM) to adjust for confounders, a multivariate Cox proportional hazard regression model, and performed subgroup analysis.

We enrolled 1706 patients with acute heart failure (318 albumin users and 1388 nonalbumin users). The 30-day overall mortality rate was 15.1% (258/1706). After PSM, the 30-day overall mortality was 22.9% (67/292) in the nonalbumin group and 13.7% (40/292) in the albumin group. In the Cox regression model, after propensity matching, the albumin use group was associated with a 47% reduction in 30-day overall mortality [hazard ratio (HR) = 0.53, 95% confidence interval (CI): 0.36-0.78, P = 0.001]. In subgroup analysis, the association was more significant in males, patients with heart failure with reduced ejection fraction (HFrEF), and nonsepsis patients.

In conclusion, our investigation suggests that the use of albumin was associated with lower 30-day mortality in patients with acute heart failure, especially in males, those aged >75 years, those with HFrEF, those with higher N-terminal pro-brain natriuretic peptide levels, and those without sepsis.