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Association between albumin administration and survival in cardiac surgery: a retrospective cohort study

  • Adam J. Kingeter
  • Karthik Raghunathan
  • Sibyl H. Munson
  • David K. Hayashida
  • Xuan Zhang
  • Sloka Iyengar
  • Martin Bunke
  • Andrew D. Shaw
Reports of Original Investigations

Abstract

Purpose

Albumin is widely used during and after on-pump cardiac surgery, although it is unclear whether this therapy improves clinical outcomes.

Methods

This observational study utilized the Cerner Health Facts® database (a large HIPAA-compliant clinical-administrative database maintained by Cerner Inc., USA) to identify a cohort of 6,188 adults that underwent on-pump cardiac surgery for valve and/or coronary artery procedures between January 2001 and March 2013. Of these, 1,095 patients who received 5% albumin with crystalloid solutions and 1,095 patients who received crystalloids alone on the day of or the day following cardiac surgery were selected by propensity-score matching. The primary outcome was all-cause in-hospital mortality. Three secondary outcomes analyzed include acute kidney injury severity, major morbidity composite, and all-cause 30-day readmissions.

Results

In the propensity-score matched cohort, receipt of perioperative 5% albumin was associated with decreased risk of in-hospital mortality (odds ratio [OR], 0.5; 95% confidence interval [CI], 0.3 to 0.9; P = 0.02) and lower all-cause 30-day readmission rates (OR, 0.7; 98.3% CI, 0.5 to 0.9; P < 0.01). Albumin therapy was not associated with differences in overall major morbidity (OR, 0.9; 98.3% CI, 0.7 to 1.2; P = 0.39; composite) or acute kidney injury severity (OR, 0.9; 98.3% CI, 0.6 to 1.4; P = 0.53) compared with therapy with crystalloid solutions.

Conclusions

In this large retrospective study, use of 5% albumin solution was associated with significantly decreased odds of in-hospital mortality and all-cause 30-day readmission rate compared with administration of crystalloids alone in adult patients undergoing on-pump cardiac surgery. These results warrant further studies to examine fluid receipt, including 5% albumin, in surgical populations via randomized-controlled trials.

Association entre l’administration d’albumine et la survie en chirurgie cardiaque : une étude de cohorte rétrospective

Résumé

Objectif

L’albumine est largement utilisée au cours de la chirurgie cardiaque pendant et après la circulation extra-corporelle (CEC), bien qu’on ne sache pas si ce traitement améliore l’évolution clinique.

Méthodes

Cette étude observationnelle a utilisé la base de données Cerner Health Facts® (une grande base de données clinico-administrative conforme à la réglementation HIPAA et tenue par Cerner Inc., aux États-Unis) pour identifier une cohorte de 6188 adultes ayant bénéficié d’une chirurgie cardiaque sous CEC pour des procédures valvulaires et/ou coronariennes entre janvier 2001 et mars 2013. Parmi eux, 1095 patients ayant reçu de l’albumine à 5% et des solutions de cristalloïdes, d’une part, et 1095 patients ayant reçu des cristalloïdes seuls le jour même ou le jour suivant la chirurgie, d’autre part, ont été sélectionnés par appariement de score de propension. Le principal critère d’évaluation était la mortalité toutes causes confondues durant l’hospitalisation. Trois critères d’évaluation secondaires ont été analysés: la sévérité des lésions rénales aiguës, un critère composite de morbidité majeure et le nombre de réhospitalisations dans les 30 jours indépendamment de la cause.

Résultats

Dans la cohorte appariée selon le score de propension, l’administration périopératoire d’albumine à 5% a été associée à une baisse du risque de mortalité à l’hôpital (rapport de cotes [OR], 0,5; intervalle de confiance [IC] à 95%: 0,3 à 0,9; P = 0,02) et à un plus faible taux de réhospitalisation toutes causes confondues (OR, 0,7; IC à 98,3%, 0,5 à 0,9; P < 0,01). Le traitement avec l’albumine n’a pas été associé à des différences de morbidité majeure globale (OR, 0,9; IC à 98,3%, 0,7à 1,2; P = 0,39; composite) ou de sévérité des lésions rénales aiguës (OR, 0,9; IC à 98,3%, 0,6 à 1,4; P = 0,53) comparativement au traitement avec des solutions de cristalloïdes.

Conclusions

Dans cette grande étude rétrospective, l’utilisation d’une solution d’albumine à 5% a significativement diminué les risques de mortalité hospitalière et de réhospitalisation dans les 30 jours comparativement aux cristalloïdes seuls chez des patients subissant une chirurgie cardiaque sous CEC. Ces résultats justifient des études supplémentaires sous forme d’essais contrôlés randomisés pour analyser l’administration des fluides, dont l’albumine à 5% dans les populations chirurgicales.

Notes

Conflicts of interest

Martin Bunke is an employee of Grifols, Inc. Sibyl Munson, David Hayashida, Xuan Zhang, and Sloka Iyengar are consultants of Boston Strategic Partners, Inc., which has received research funding from Grifols for the conduct of this study and assistance with manuscript preparation. Andrew Shaw has previously been a consultant to Grifols, but is not currently. The other authors have no conflicts of interest to declare.

Editorial responsibility

This submission was handled by Dr. Philip M. Jones, Associate Editor, Canadian Journal of Anesthesia.

Author contributions

Adam J. Kingeter helped design the study and prepare the manuscript. Karthik Raghunathan and Sibyl H. Munson helped analyze the data and prepare the manuscript. David K. Hayashida and Xuan Zhang helped analyze the data. Sloka Iyengar helped prepare the manuscript. Martin Bunke helped design the study. Andrew D. Shaw helped design the study, analyze data, and prepare the manuscript.

Funding

This study was sponsored by Grifols, Inc., a manufacturer of 5% albumin.

Supplementary material

12630_2018_1181_MOESM1_ESM.pdf (494 kb)
Supplementary material 1 (PDF 493 kb)

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Copyright information

© Canadian Anesthesiologists' Society 2018

Authors and Affiliations

  • Adam J. Kingeter
    • 1
  • Karthik Raghunathan
    • 2
  • Sibyl H. Munson
    • 3
  • David K. Hayashida
    • 3
  • Xuan Zhang
    • 3
  • Sloka Iyengar
    • 3
  • Martin Bunke
    • 4
  • Andrew D. Shaw
    • 5
  1. 1.Department of AnesthesiologyVanderbilt University Medical CenterNashvilleUSA
  2. 2.Duke University Medical Center and Durham VA Medical CenterDurhamUSA
  3. 3.Boston Strategic Partners, Inc.BostonUSA
  4. 4.Grifols, Inc.Research Triangle ParkUSA
  5. 5.University of AlbertaEdmontonCanada

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