Is albumin administration in the acutely ill associated with increased mortality? Results of the SOAP study.
BACKGROUND
Albumin administration in the critically ill has been the subject of some controversy. We investigated the use of albumin solutions in European intensive care units (ICUs) and its relationship to outcome.


METHODS
In a cohort, multicenter, observational study, all patients admitted to one of the participating ICUs between 1 May and 15 May 2002 were followed up until death, hospital discharge, or for 60 days. Patients were classified according to whether or not they received albumin at any time during their ICU stay.


RESULTS
Of 3,147 admitted patients, 354 (11.2%) received albumin and 2,793 (88.8%) did not. Patients who received albumin were more likely to have cancer or liver cirrhosis, to be surgical admissions, and to have sepsis. They had a longer length of ICU stay and a higher mortality rate, but were also more severely ill, as manifested by higher simplified acute physiology score (SAPS) II and sequential organ failure assessment (SOFA) scores than the other patients. A Cox proportional hazard model indicated that albumin administration was significantly associated with decreased 30-day survival. Moreover, in 339 pairs matched according to a propensity score, ICU and hospital mortality rates were higher in the patients who had received albumin than in those who had not (34.8 versus 20.9% and 41.3 versus 27.7%, respectively, both p < 0.001).


CONCLUSIONS
Albumin administration was associated with decreased survival in this population of acutely ill patients. Further prospective randomized controlled trials are needed to examine the effects of albumin administration in sub-groups of acutely ill patients.
Vincent
Jean-Louis
JL
Department of Intensive Care, Erasme Hospital, Free University of Brussels, Route de Lennik 808, 1070 Brussels, Belgium. jlvincen@ulb.ac.be
Sakr
Yasser
Y
Reinhart
Konrad
K
Sprung
Charles L
CL
Gerlach
Herwig
H
Ranieri
V Marco
VM
D017677:Age Distribution; D000418:Albumins / Q000627:therapeutic use*; D015331:Cohort Studies; D015897:Comorbidity; D003422:Critical Care / Q000379:methods / Q000706:statistics & numerical data*; D016638:Critical Illness / Q000401:mortality*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008103:Liver Cirrhosis / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000401:mortality; D010043:Outcome and Process Assessment, Health Care; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000401:mortality; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data; D016019:Survival Analysis
D000418:Albumins