Early Albumin Infusion Is Associated With Greater Survival to Discharge Among Patients With Sepsis/Septic Shock Who Develop Severe Acute Kidney Injury Among Patients With Sepsis/Septic Shock Who Develop Severe Acute Kidney Injury

被引:5
|
作者
Raghunathan, Karthik [1 ]
Kempker, Jordan A. [2 ]
Davis, E. Anne [3 ]
Sindhwani, Navreet S. [3 ]
Telang, Santosh [4 ]
Lodaya, Kunal [4 ]
Martin, Greg S. [2 ]
机构
[1] Duke Univ, Dept Anesthesiol, Durham, NC 27710 USA
[2] Emory Univ, Dept Med, Atlanta, GA USA
[3] Grifols Shared Serv North Amer SSNA, Durham, NC USA
[4] Boston Strateg Partners Inc, Boston, MA USA
关键词
acute kidney injury; human serum albumin; length of stay; sepsis; septic shock; HYPOPROTEINEMIC PATIENTS; COST-EFFECTIVENESS; SEVERE SEPSIS; INFLAMMATION; REPLACEMENT; PREVENTION; MANAGEMENT; FUROSEMIDE; MORTALITY; THERAPY;
D O I
10.1097/CCE.0000000000000793
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Importance: Adults hospitalized with sepsis/septic shock commonly develop acute kidney injury (AKI) which imposes a significant burden on the healthcare system. The administration of early human albumin in this patient population may yield more efficient healthcare resource utilization. Objectives: To examine the association between early use of albumin and time to discharge in adults who develop severe AKI while hospitalized with sepsis/septic shock. Design: Retrospective cohort study using de-identified electronic health records from a national database (Cerner Health Facts; Cerner Corp., Kansas City, MO). Setting and participants: Patients (n = 2,829) hospitalized between January 2013 and April 2018 with a diagnosis of sepsis/septic shock (identified using International Classification of Diseases, 9th Revision and 10th Revision codes) who developed severe AKI (stage 3 according to Kidney Disease Improving Global Outcomes criteria) during hospitalization (n = 2,845 unique encounters). Main outcomes and measures: Patients were grouped according to timing of albumin exposure: within less than or equal to 24 hours of admission ("early albumin") or unexposed/exposed late ("nonearly albumin"). A cause-specific hazard model, censoring for death/discharge to hospice, was used to examine the association between "early albumin" and the rate of hospital discharge with clinical stability. Results: Albumin was administered early in 8.6% of cases. Cases with early albumin administration had a median time to discharge of 13.2 days compared with 17.0 in the nonearly group (Log-rank p < 0.0001). An adjusted analysis showed that the rate of hospital discharge with clinical stability increased by 83% in the early albumin group compared with the nonearly group (hazard ratio, 1.832; 95% CI, 1.564-2.146; p < 0.001 nonearly group. Conclusions and relevance: The use of albumin within 24 hours of hospital admission was associated with a shorter time to discharge and a higher rate of discharge with clinical stability, suggesting an improvement in healthcare resource utilization among patients with sepsis/septic shock who developed stage 3 AKI during hospitalization.
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页数:10
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