Albumin administration and 28-day mortality in sepsis-induced myocardial injury: a propensity score-matched analysis

Current evidence on the therapeutic effects of albumin administration in critically ill patients with sepsis-induced myocardial injury (SIMI) remains insufficient. To address this knowledge gap, we performed a retrospective cohort study to examine the association between albumin supplementation and key clinical outcomes in this patient population.

This study included adult patients with SIMI who were treated in the intensive care unit (ICU). Data were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database (version 2.2). Patients were categorized into two groups based on whether they received albumin infusion during their ICU stay: the albumin group and the non-albumin group. The primary endpoint was all-cause 28-day mortality. Kaplan-Meier (KM) curves were constructed to estimate survival probabilities, and log-rank tests were used to compare survival distributions between the two groups. Subgroup analyses were performed to explore heterogeneity in treatment effects and to assess the association of albumin infusion with outcomes across different patient characteristics.

A total of 433 patients were included in the albumin infusion group and 1126 in the non-albumin infusion group. After 1:1 propensity score matching (PSM), 648 patients were included in the analysis (324 in each group). Following PSM, no statistically significant differences were observed in mortality outcomes between the albumin and non-albumin groups: 28-day mortality (HR = 0.97, 95% confidence interval[CI]: 0.57-1.64, p = 0.90), 60-day mortality (HR = 0.89, 95%CI 0.56-1.41, p = 0.63), 90-day mortality (HR = 0.89, 95%CI 0.57-1.39, p = 0.61), and in-hospital mortality (HR = 0.85, 95%CI 0.55-1.33, p = 0.49). Notably, the albumin group exhibited significantly prolonged ICU length of stay (9.06 [4.65, 16.72] vs. 5.65[2.76, 10.50] days, P<0.01) and hospital length of stay (22.56 [13.42, 34.05] vs. 14.50 [8.32, 22.36] days, P<0.01) compared to the non-albumin group.

In this propensity score-matched cohort of critically ill patients with sepsis-induced myocardial injury, albumin-based resuscitation strategy demonstrated comparable 28-day survival outcomes to crystalloid-focused fluid management.