Use of albumin as a risk factor for hospital mortality among burn patients in Brazil: non-concurrent cohort study

Abstract

CONTEXT AND OBJECTIVE: Among burn patients, it is common to use colloidal substances under the justification that it is necessary to correct the oncotic pressure of the plasma, thereby reducing the edema in the burnt area and the hypotension. The aim here was to assess the risk of hospital mortality, comparing the use of albumin and crystalloid solutions for these patients. DESIGN AND SETTING: Non-concurrent historical cohort study at Faculdade de Medicina de Marília; within the Postgraduate program on Internal and Therapeutic Medicine, Universidade Federal de São Paulo; and at the Brazilian Cochrane Center. METHODS: Burn patients hospitalized between 2000 and 2001, with registration in the Hospital Information System, who received albumin, were compared with those who received other types of volume replacement. The primary outcome was the hospital mortality rate. The data were collected from files within the Datasus software. RESULTS: 39,684 patients were included: 24,116 patients with moderate burns and 15,566 patients with major burns. Among the men treated with albumin, the odds ratio for the risk of death was 20.58 (95% confidence interval, CI: 11.28-37.54) for moderate burns and 6.24 (CI 5.22-7.45) for major burns. Among the women, this risk was 40.97 for moderate burns (CI 21.71-77.30) and 7.35 for major burns (CI 5.99-9.01). The strength of the association between the use of albumin and the risk of death was maintained for the other characteristics studied, with statistical significance. CONCLUSION: The use of albumin among patients with moderate and major burns was associated with considerably increased mortality.

Factors affecting mortality among victims of electrical burns

“…[22] The effects of transfusion requirements in defining mortality risk factors in burns also were not studied considerably previously. In concomitant with our results, Caleman et al [23] defined the albumin transfusion requirement as a risk factor for mortality in burn patients. Lu et al [24] did not define the erythrocyte or plasma transfusion as a predictor of mortality in patients with a burn injury.…”

Plasma and Dietary Antioxidant Status as Cardiovascular Disease Risk Factors: A Review of Human Studies

“…Increase in serum albumin per unit has been reported to have a 12% lower CVD incidence risk over a three-year period among the elderly [20]. The associations between low albumin and all-cause mortality have also been reported consistently in previous studies [21,22,23,24]. …”

Economic evaluation of human albumin use in patients with nephrotic syndrome in four Brazilian public hospitals: pharmacoeconomic study

“…For example, a non-concurrent historical cohort study that was carried out in Brazil based on DATASUS records found that use of albumin among patients with major burns was associated with considerably increased mortality (seven times higher than when crystalloid solutions were used). 40 The clinical evaluation on the effectiveness of intermediate outcomes for weight, diuresis and fluid balance parameters more directly related to the care process showed differences between the groups in this study. However, within clinical practice, these differences would probably not demonstrate observable relevance.…”