Assessing the clinical impact of albumin infusion in critically ill ICU patients with acute myocardial infarction and hypoalbuminemia: a retrospective propensity score-matched cohort study

The clinical impact of exogenous albumin supplementation in critically ill hypoalbuminemic patients with acute myocardial infarction (AMI) remains uncertain. This retrospective cohort study utilized the MIMIC-IV (Medical Information Mart for Intensive Care-IV) database. Adult ICU patients with AMI and hypoalbuminemia were included. Albumin infusion during the ICU stay was considered clinician-driven supportive therapy rather than a protocol-directed intervention. Propensity score matching (PSM) was performed in a 1:1 ratio, yielding 153 patients in the albumin group and 153 matched controls. The primary outcomes were 30-day and 90-day all-cause mortality. Secondary outcomes included ICU and hospital length of stay. Multivariable regression analyzes were performed to adjust for potential confounders. The pre-matched cohort included 1,285 patients. After PSM, 306 patients (153 per group) with balanced baseline characteristics were included in the analysis. No significant differences were observed in 30-day mortality (34.0% vs. 35.9%, p = 0.719) or 90-day mortality (45.8% vs. 45.1%, p = 0.909). Cox regression showed no independent association between albumin infusion and 30-day mortality (HR 0.85; 95% CI 0.57–1.27; p = 0.429) or 90-day mortality (HR 0.97; 95% CI 0.68–1.37; p = 0.843). However, albumin infusion was associated with longer ICU stay (β = 4.34 days; 95% CI 2.91–5.76; p < 0.001) and hospital stay (β = 4.43 days; 95% CI 1.12–7.74; p = 0.009). In critically ill hypoalbuminemic patients with AMI, albumin infusion was not associated with reduced short-term mortality but was associated with longer ICU and hospital stays, likely reflecting greater illness severity rather than a causal treatment effect. Further prospective studies are warranted. This study assesses the clinical impact of albumin infusion in patients with acute myocardial infarction and hypoproteinemia. Patients with acute myocardial infarction and hypoproteinemia do not see any reduction in 30 or 90-day all-cause mortality risk. The pre-matched cohorts included 1285 patients. 153 patients were included in the final analysis after PSM, and the baseline data were balanced between the two groups. Infusion of albumin significantly extended hospital and ICU stay, but was not significantly connected with 30-day or 90-day death.