Human albumin use at hospitals in the Metropolitan Region of Rio de Janeiro, Brazil

Matos, Guacira Corrêa de; Rozenfeld, Suely; Martins, Mônica

doi:10.1590/s0102-311x2010000500020

Cited by 9 publications

(5 citation statements)

References 21 publications

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“… 13 After the infusion of exogenous ALB, most of the ALB would leak outside blood vessels within 2 days, which may result in edema around the incision, offering conditions for bacterial colonization and aggrandizing the risk of infection. 14 , 15 , 16 In addition, although exogenous ALB contained different amino acids, it excluded tryptophan and isoleucine, so it has low nutritional value. 17 As a result, the European Forum of Medical Associations did not recommend applying ALB to correct postoperative hypoalbuminemia.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Risk Factors for Predicting Postoperative Human Serum Albumin Infusion after Hip Fracture Surgery: Development and Validation of a Nomogram

Chen¹,

Liu²,

Pan³

et al. 2023

Balkan Med J

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Background: As one of the adverse events after hip fracture surgery, hypoalbuminemia is usually treated using human serum albumin infusion. However, the application of human serum albumin may cause complications such as postsurgical infection and increased mortality. Aims: To examine the preoperative risk factors of human serum albumin infusion after hip fracture surgery, establish a nomogram prediction model, and verify its accuracy. Study Design: A retrospective cross-sectional study. Methods: Eligible patients who underwent hip fracture surgery were divided into the infusion and non-infusion groups according to whether human serum albumin was infused or not. All patients were divided randomly into a training set and a testing set in line with the ratio of 7:3. In the training set, independent risk factors of postoperative human serum albumin infusion were determined by univariate logistic regression analysis, LASSO regression, and multivariate logistic regression analysis. Then, a nomogram model was established. Furthermore, the receiver operating characteristic curve and calibration curve were plotted, and decision curve analysis was performed for the training and testing sets to assess the predictability, discriminative ability, and clinical usefulness of the model. Results: This study included a total of 1,339 eligible patients, 141 of whom were injected with human serum albumin postoperatively. Altogether, the training set incorporated 939 patients, and the testing set included 400 patients. Multivariate logistic analysis indicated five independent risk factors, including chronic lung disease (odds ratio, 95% confidence interval, 2.618, 1.413-4.849, p = 0.002), (albumin; odds ratio, 95% confidence interval, 0.842, 0.787-0.900, p < 0.001), prothrombin time (odds ratio, 95% confidence interval, 1.252, 1.071-1.463, p = 0.005), red blood cells (odds ratio, 95% confidence interval, 0.370, 0.228-0.602, p < 0.001), and type of anesthesia (odds ratio, 95% confidence interval, 0.553, 0.327-0.937, p = 0.028). Fracture type, a clinically significant factor, was also considered. Finally, the nomogram model was built based on these seven predictors. The areas under the curve of the nomogram were 0.854 (95% confidence interval, 0.811-0.898) and 0.767 (95% confidence interval, 0.686-0.847) in the training and testing sets separately. As shown in the calibration curve, the predicted result was consistent with the observed one. The decision curve analysis indicated that the nomogram has good clinical value. Conclusion: Low preoperative serum albumin levels, low preoperative red blood cell counts, prolonged preoperative prothrombin time, history of chronic lung disease, and general anesthesia were independent risk factors for postope...

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Section: Discussionmentioning

confidence: 99%

Preoperative Risk Factors for Predicting Postoperative Human Serum Albumin Infusion after Hip Fracture Surgery: Development and Validation of a Nomogram

Chen¹,

Liu²,

Pan³

et al. 2023

Balkan Med J

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“…After the infusion of exogenous albumin, about 10% of albumin exudes from the blood vessels within 2 hours, and 75% is distributed outside the blood vessels within 2 days. Also, albumin takes a long time to decompose, and if it cannot decompose, it produces the required amino acids in the short term [ 18 , 34 ]. In addition, exogenous albumin contains different kinds of amino acids excluding tryptophan and isoleucine and has low nutritional value, and therefore, it is generally not recommended for improving nutritional status and correcting hypoproteinemia [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Value of Postoperative Serum Albumin to Predict Postoperative Complication Severity in Spinal Tuberculosis

Jiang

Zhu

et al. 2022

BioMed Research International

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Background. Many complications occur after surgery in patients with spinal tuberculosis (STB); however, the severity varies in different patients. The complications’ severity is evaluated from grades I to V by the Clavien–Dindo classification (CDC), and grade V is the most severe. Most complications are mild, and only severe complications are life threatening, and thus, it is important to identify severe complications in patients with STB. The purpose of this study was to identify the risk factors of postoperative complication severity in patients with STB. Methods. Between January 2012 and May 2021, a retrospective study included 188 patients that underwent STB debridement surgery. The patients were divided into three groups based on postoperative complication severity. Clinical characteristics measured included age, sex, body mass index (BMI), comorbidities of diabetes mellitus and pulmonary tuberculosis, alcohol use and smoking history, course of disease, preoperative hemoglobin, preoperative serum albumin, preoperative lymphocytes, preoperative erythrocyte sedimentation rate (ESR), preoperative C-reactive protein (CRP), surgical approach, operating time, blood loss during surgery, postoperative hemoglobin, and postoperative serum albumin. The clinical characteristics of patients with STB who developed postoperative complications were evaluated using logistic regression analysis. Results. 188 patients suffered at least one postoperative complication; 77, 91, and 20 patients experienced grade I, II, and III-IV complications, respectively. In the univariate analysis, sex, diabetes mellitus, postoperative hemoglobin, and postoperative albumin are statistically significant. In the multivariable analysis, postoperative albumin (adjusted odds ratio OR = 0.861 , P < 0.001 ) was an independent risk factor of the postoperative complication severity in patients with STB. Receiver operating characteristic (ROC) analysis showed that the optimal cutoff values for postoperative albumin were 32 g/L (sensitivity: 0.571, specificity: 0.714, area under the ROC curve: 0.680) and 30 g/L (sensitivity: 0.649, specificity: 0.800, area under the ROC curve: 0.697) for grade II and grade III-IV complications, respectively. Conclusions. Postoperative albumin is an independent risk factor for postoperative complication severity in patients with STB. The improvement of postoperative albumin levels may reduce the risk of severe complications in patients with STB.

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“…The WHO reported that in numerous countries, 30% of patients in public sectors and 40% of patients in private sectors are treated per standard clinical guidelines [19]. Previous studies evaluated the clinical and economic impacts of pharmaceutical guidelines in Iran, suggesting that IRUD for albumin and pantoprazole ranged between 36% and 93% [12,20,21]. Albumin and IV pantoprazole IRUD in the studied hospitals, before our intervention (July 2016), has dramatically risen from 48% to 70% in 2015 and 2016, respectively.…”

Section: Discussionmentioning

confidence: 99%

Enhancing the Rational Use of Albumin and Intra-venous Pantoprazole in Hospitals by Implementing Pharmaceutical Guidelines in Hospitals: A Quasi-experimental study

Sharifi

Jahromi

Raoofi

et al. 2021

PBR

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Background: Irrational use of drugs is a serious global problem, especially in developing countries. Scientific evidence has announced albumin and intravenous pantoprazole as expensive drugs, i.e., relatively irrationally applied in hospitals without following the guidelines. Objectives: Considering health cost management policy in Iran, this study aimed to evaluate the effects of implementing pharmaceutical guidelines to rationalize and reduce the use of albumin and intravenous pantoprazole and the related inappropriate costs. Methods: This quasi-experimental study was conducted from January 2016 to October 2018 in two teaching Hospitals in Jahrom City, Iran. Pharmaceutical guidelines were implemented throughout the physical training as well as a pharmacist-led intervention and supervising. All inpatient prescriptions of the studied medicines were evaluated. Results: Before conducting the intervention (June 2016), an average of 357 albumin vials were monthly used; after performing the interventions, 166 and 167 vials were used in 2017 and 2018, respectively. Reduced albumin use rate equaled 48%, i.e., significant (P=0.002). Annual cost-saving was estimated to be 25000 USD. In comparison to the previous year, there were 46% and 70% reductions in the mean number of pantoprazole vials prescribed in 2017 and 2018, respectively (P=0.005).Consuming pantoprazole was measured to be 1457 vials per month in 2017 and 795 in 2018, i.e., significant (P=0.002). Cost-Saving in intravenous pantoprazole was estimated to be 16000 USD in 2017 and 25000 USD in 2018. Conclusion: Prescription strategies, such as pharmaceutical guidelines with educational measures, pharmacist-led intervention, monitoring the prescribing drug, and feedback to prescribers can significantly decrease the inappropriate use of expensive drugs and their costs.

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Human albumin use at hospitals in the Metropolitan Region of Rio de Janeiro, Brazil

Abstract: The study analyzes the use of human albumin in hospitals in Rio de Janeiro, Brazil, using inpatient

Cited by 9 publications

References 21 publications

Preoperative Risk Factors for Predicting Postoperative Human Serum Albumin Infusion after Hip Fracture Surgery: Development and Validation of a Nomogram

Preoperative Risk Factors for Predicting Postoperative Human Serum Albumin Infusion after Hip Fracture Surgery: Development and Validation of a Nomogram

Value of Postoperative Serum Albumin to Predict Postoperative Complication Severity in Spinal Tuberculosis

Enhancing the Rational Use of Albumin and Intra-venous Pantoprazole in Hospitals by Implementing Pharmaceutical Guidelines in Hospitals: A Quasi-experimental study

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