Objective: This study aimed to explore the relationship between albumin level with short- and long-term outcomes in sepsis patients admitted in the intensive care unit (ICU) based on a large public database to provide clinical evidence for physicians to make individualized plans of albumin supplementation.
Methods: Sepsis patients admitted in the ICU in MIMIC-IV were included. Different models were performed to investigate the relationships between albumin and mortalities of 28-day, 60-day, 180-day and 1-year. Smooth fitting curves were performed.
Results: A total of 5357 sepsis patients were included. Mortalities of 28-day, 60-day, 180-day and 1-year were 29.29% (n = 1569), 33.92% (n = 1817), 36.70% (n = 1966) and 37.71% (n = 2020). In the fully adjusted model (adjusted for all potential confounders), with each 1g/dL increment in albumin level, the risk of mortality in 28-day, 60-day, 180-day and 1-year decreased by 39% (OR = 0.61, 95% CI: 0.54– 0.69), 34% (OR = 0.66, 95% CI: 0.59– 0.73), 33% (OR = 0.67, 95% CI: 0.60– 0.75), and 32% (OR = 0.68, 95% CI: 0.61– 0.76), respectively. The non-linear negative relationships between albumin and clinical outcomes were confirmed by smooth fitting curves. The turning point of albumin level was 2.6g/dL for short- and long-term clinical outcomes. When albumin level ≤ 2.6g/dL, with each 1g/dL increment in albumin level, the risk of mortality in 28-day, 60-day, 180-day and 1-year decreased by 59% (OR = 0.41, 95% CI: 0.32– 0.52), 62% (OR = 0.38, 95% CI: 0.30– 0.48), 65% (OR = 0.35, 95% CI: 0.28– 0.45), and 62% (OR = 0.38, 95% CI: 0.29– 0.48), respectively.
Conclusion: Albumin level was associated with short- and long-term outcomes in sepsis. Albumin supplementation might be beneficial for septic patients with serum albumin< 2.6g/dL.
Keywords: albumin, mortality, inflammation, sepsis, MIMIC-IV