Albumiiniliuos ja pitkäaikaiskuolleisuus sydänkirurgiassa – satunnaistetun kliinisen tutkimuksen jatkotutkimus

The impact of albumin on mortality in cardiac surgery has almost exclusively been compared to HES which has been withdrawn from clinical use due to safety concerns. This follow-up of the ALBICS (Albumin In Cardiac Surgery) trial investigated the effect of albumin on long-term mortality in cardiac surgery using Ringer acetate as the comparator. Altogether 1386 patients received 4% albumin or Ringer acetate for cardiopulmonary bypass priming and perioperative volume replacement. I retrieved mortality data from a centralized repository integrating clinical and administrative records. I defined major adverse events (MAEs) with slight modifications from those used in the ALBICS trial. I compared survival between study groups and across each MAE using Kaplan–Meier curves and log-rank tests, and estimated hazard ratios using Cox regression. The mean (range) time from surgery to mortality data collection was 6.6 years (5.2–8.0). At five years, mortality was 8% (56 patients) in the albumin group and 9% (59 patients) in the Ringer group (p=0.76). By the end of the observation period, mortality was 13% (87 patients) in both treatment groups (log-rank χ²=0.004, p=0.95). In a multivariable Cox regression analysis including all MAEs and adjusted for the ALBICS study group and EuroSCORE II, infection (19% vs 7%, χ²=16.3, p<0.001) and acute kidney injury (20% vs. 7%, χ²=10.1, p=0.001) were independently associated with mortality. Albumin infusion did not reduce long-term mortality in cardiac surgery, compared to Ringer acetate. These findings do not support the use of albumin in low-risk cardiac surgery.