Early albumin infusion is associated with lower mortality in patients with sepsis and concurrent heart failure: a retrospective cohort study

We retrospectively examined the association between albumin administration during the first 24 h after intensive care unit (ICU) admission and all-cause mortality in patients with sepsis and concurrent heart failure (HF) using MIMIC-IV version 3.1. The cohort included 4063 adults, of whom 432 were in the early-albumin group and 3631 were in the control group. The primary endpoint was 28-day all-cause mortality after ICU admission; secondary mortality endpoints were 90- and 365-day all-cause mortality. The primary analysis used multivariable Cox proportional-hazards models in the full cohort, with analyses in the fixed propensity-score-matched cohort providing supportive evidence. In the full cohort, early albumin administration was associated with lower all-cause mortality at 28 days (adjusted hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.55–​0.85; P < 0.001), 90 days (adjusted HR, 0.71; 95% CI, 0.59–0.86; P < 0.001), and 365 days (adjusted HR, 0.70; 95% CI, 0.59–0.82; P < 0.001). Directionally consistent associations were observed in the matched Cox models. Early albumin administration was not associated with lower documented volumes of major isotonic crystalloids (0.9% saline plus lactated Ringer’s) during the first 48 h after ICU admission. In this retrospective cohort, early albumin administration during the first 24 h after ICU admission was associated with lower 28-, 90-, and 365-day all-cause mortality, but not with lower documented major isotonic crystalloid administration. These findings are observational and do not establish causality.