Evaluation of albumin utilization, guideline compliance, and cost in intensive care units: a multicenter point...

Intravenous (IV) albumin is widely used in intensive care units (ICUs), yet its use often deviates from evidence-based recommendations, leading to unnecessary costs. This study evaluates the indications for the use of IV albumin in critically ill patients, compliance with the 2024 "Use of Intravenous Albumin" guidelines, and the associated cost burden.

A prospective, point prevalence-based observational study was conducted across seven hospitals in Türkiye over one week. Data on IV albumin utilization, guideline compliance, patient demographic and clinical characteristics, and associated costs were collected and analyzed. Statistical analyses included the Kruskal-Wallis test for comparisons of albumin utilization and logistic regression to assess factors influencing its use.

Among 385 ICU patients monitored, 56 (14.5%) received IV albumin therapy. The median age was 68 years (Interquartile range-IQR: 54.2-77.7), and 67.9% were male. The most common physician-reported indications for initiating albumin therapy were low serum albumin levels (41.1%), fluid shifts or intravascular volume support (21.4%), and sepsis or septic shock (14.3%). The desired clinical target was achieved in 73.2% of cases; however, guideline compliance was 0%. Albumin use differed significantly across ICU types (p = 0.049), with a median consumption of 667 (IQR: 250-1,083) vials per 1,000 patient-days and an estimated cost of $70,617.86. Logistic regression identified total hospital stay (p = 0.028) and Acute Physiology and Chronic Health Evaluation (APACHE) II score (p = 0.040) as significant predictors, while mechanical ventilation (MV) duration showed borderline significance (p = 0.070). The model's classification accuracy was 78.6%.

This study highlights widespread non-compliance with guidelines for IV albumin use in ICUs, resulting in substantial costs. These findings underscore the need to improve compliance with evidence-based guidelines to optimize albumin utilization and reduce economic burden. Future studies should explore the potential impact of targeted interventions, including pharmacist involvement, on improving prescribing practices.

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