Impact of early albumin therapy on 28-day survival in ICU patients with septic shock concurrent hypoalbuminemia: a retrospective analysis of combined clinical datasets.

BACKGROUND To evaluate the association between early albumin infusion and 28-day mortality in intensive care unit (ICU) patients with septic shock and concurrent hypoalbuminemia. METHODS This study analyzed data from the MIMIC-IV database and admission records from the university-affiliated teaching hospital ICU. Patients with septic shock and concurrent hypoalbuminemia were categorized into early albumin infusion (within 72 h of ICU admission) and late albumin infusion (after 72 h of ICU admission), regardless of dosage or colloid osmotic pressure. The primary outcome was the 28-day mortality rate. RESULTS In the MIMIC-IV cohort, 1,216 patients received an albumin infusion, including 546 with early infusion and 670 with late infusion (odds ratios [ORs]=1.556, 95% confidence intervals [95% CIs]: 1.193-2.030). Early albumin infusion was associated with significantly higher 28-day mortality compared to late or no infusion. Subgroup analysis showed a survival benefit in patients with severe hypoalbuminaemia, but worse outcomes in those with mild-to-moderate hypoalbuminaemia. These findings were partially validated in an independent cohort from Sun Yat-sen Memorial Hospital (n=1,233), where similar trends were observed. Early infusion was associated with increased mortality, and albumin use in mild-to-moderate hypoalbuminaemia was associated with worse survival. CONCLUSION Early albumin infusion for patients with septic shock did not demonstrate a clear clinical benefit regarding 28-day mortality. Late infusion, however, appeared to be associated with improved survival outcomes. Among patients with septic shock and severe hypoalbuminemia, albumin infusion was associated with higher 28-day survival. In contrast, for those with mild-to-moderate hypoalbuminemia, albumin infusion did not offer a significant survival advantage.