Early combination of albumin with crystalloids administration might be beneficial for the survival of septic patients: a retrospective analysis from MIMIC-IV database

Abstract

Background Fluid therapy is a cornerstone in the treatment of sepsis. Recently, the guidelines have recommended the combined administration that using crystalloids plus albumin for septic patients, but the optimal timing for albumin combined is still unclear. The objective of this study was to investigate the association of timing of albumin combined with 28-day mortality in patients with sepsis. Methods We involved septic patients from the Medical Information Mart for Intensive Care (MIMIC)-IV database, and these patients were categorized into crystalloids group (crystalloids alone) and early combination group (crystalloids combined albumin at 0–24 h). The primary outcome was 28-day mortality. We used propensity score matching (PSM) to adjust confounding and restricted mean survival time (RMST) analysis was conducted to quantify the beneficial effect on survival due to the combination group. Results We categorized 6597 and 920 patients in the “crystalloids alone” and “early combination”, respectively. After PSM, compared to the crystalloids group, the combination group was associated with the increased survival among 28-day (increased survival: 3.39 days, 95% CI 2.53–4.25; P < 0.001) after ICU admission. Patients who received albumin combination at the first 24-h was associated with prolonged LOS in ICU (10.72 days vs. 8.24 days; P < 0.001) but lower risk of 28-day mortality (12.5% vs 16.4%, P = 0.003) than those received crystalloids alone. Conclusion In septic patients, receiving albumin combined within the first 24-h after crystalloids administration was associated with an increment of survival in 28 days.

Influence of the trajectory of the urine output for 24 h on the occurrence of AKI in patients with sepsis in intensive care unit

“…The MIMIC-IV database is a large, openly accessible, and relational database [ 16 , 17 ]. It contains a comprehensive information on more than 250,000 electronic admission records of the Beth Israel Deaconess Medical Center in Boston, Massachusetts from 2008 to 2019.…”

“…We determined the study population based on the Sepsis 3.0 criteria, that is, on the basis of suspected or confirmed infection plus the Sequential Organ Failure Assessment (SOFA) score with an acute elevation greater than 2 points [ 17 , 20 ]. In addition, patients younger than 18 years old, characterized as in-hospital death or with AKI occurring within 24 h of diagnosis of sepsis, or with missing weight information were excluded.…”

Influence of ambulatory blood pressure-related indicators within 24 h on in-hospital death in sepsis patients

“…The data used in this study were obtained from version 0.4 of the MIMIC-IV database. This is a large, single-center, and open-access database that includes data on 257,366 admissions from 196,527 patients admitted to Beth Israel Deaconess Medical Center from 2008 to 2019 [10][11][12][13]. MIMIC-IV was approved by the institutional review boards of Beth Israel Deaconess Medical Center (Boston, Massachusetts, USA) and Massachusetts Institute of Technology (Cambridge, Massachusetts, USA).…”

Preoperative Glucose-to-Lymphocyte Ratio is an Independent Predictor for Acute Kidney Injury After Cardiac Surgery in Patients in Intensive Care Unit

“…The data were collected from a large US-based critical care database called Medical Information Mart for Intensive Care IV version 1.0 (MIMIC IV v1.0). 15 It is a publicly and freely accessible database containing information of more than 50,000 patients admitted to the ICUs of Beth Israel Deaconess Medical Center in Boston, MA, from 2008 to 2019. The database has been approved by the Institutional Review Board (IRB) of the Massachusetts Institute of Technology (MIT).…”