Albumin in patients with ARDS in ICU: a retrospective study from eICU and MIMIC-III database

Although early administration of albumin has been shown to improve oxygenation and maintain hemodynamic stability in patients with acute respiratory distress syndrome (ARDS), whether the addition therapy of albumin can improve the outcome of ARDS patient was still unknow. Therefore, this study aims to evaluate the efficacy of early albumin therapy in ARDS patients diagnosed according to the Berlin definition. We conducted a multicenter, retrospective study utilizing data from the eICU Collaborative Research Database and the MIMIC-III Database. Inverse probability of treatment weighting (IPTW) and propensity score matching were implemented to further adjust for confounding variables between the groups. Cox proportional hazards models were applied to estimate the association between albumin administration within 48 hours of admission and 28-day mortality in patients with ARDS. Kaplan–Meier survival curves were constructed, and the log-rank test was employed to assess the association between 28-day mortality and albumin therapy in the two groups. Following a review of over 200,000 subjects from the eICU database, 3,371 eligible patients with ARDS were identified according to the inclusion and exclusion criteria. The albumin therapy was not associated with 28-day mortality (HR, 1.12; 95% CI, 0.76–1.67; P = 0.6) in the IPTW cohort and was also not associated with 28-day mortality (HR, 0.88; 95% CI, 0.62–1.24; P = 0.5) in the PSM cohort in eICU database. Moreover, the albumin therapy was not associated with 28-day mortality (HR, 1.12; 95% CI, 0.76–1.67; P = 0.6) in the IPTW cohort and was not associated with 28-day mortality (HR, 0.95; 95% CI, 0.65–1.38; P = 0.8) in the PSM cohort in MIMIC-III database. In conclusion, our findings suggested that ARDS patients receiving albumin therapy did not improve the outcomes. Using albumin treatment may lead to albumin leakage when the damaged endothelial cells cause severe leakage of capillaries may even aggravate tissue edema and thus prolong the hospital stay, ICU stay, and mechanical ventilation duration.