Research

Is albumin administration in the acutely ill associated with increased mortality? Results of the SOAP study

Jean-Louis Vincent¹ , Yasser Sakr¹ , Konrad Reinhart² , Charles L Sprung³ , Herwig Gerlach⁴ and V Marco Ranieri⁵ for the 'Sepsis Occurrence in Acutely Ill Patients' investigators

¹Department of Intensive Care, Erasme Hospital, Free University of Brussels, Route de Lennik 808, 1070 Brussels, Belgium

²Department of Anaesthesiology and Intensive Care, Friedrich-Schiller-University, Erlanger Allee 101, 07747, Jena, Germany

³Department of Anaesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, P.O.B. 12000, 91120 Jerusalem, Israel

⁴Department of Anaesthesiology and Intensive Care, Vivantes-Klinikum Neukölln, Rudower strasse 48, 12313 Berlin, Germany

⁵Department of Anaesthesiology and Intensive Care, S Giovanni Battista Hospital, University of Turin, Corso Dogliotti 14, 10126 Torino, Italy

author email corresponding author email

Critical Care 2005, 9:R745-R754doi:10.1186/cc3895

Published:	7 November 2005

See related commentary http://ccforum.com/content/9/6/649

Abstract

Introduction

Albumin administration in the critically ill has been the subject of some controversy. We investigated the use of albumin solutions in European intensive care units (ICUs) and its relationship to outcome.

Methods

In a cohort, multicenter, observational study, all patients admitted to one of the participating ICUs between 1 May and 15 May 2002 were followed up until death, hospital discharge, or for 60 days. Patients were classified according to whether or not they received albumin at any time during their ICU stay.

Results

Of 3,147 admitted patients, 354 (11.2%) received albumin and 2,793 (88.8%) did not. Patients who received albumin were more likely to have cancer or liver cirrhosis, to be surgical admissions, and to have sepsis. They had a longer length of ICU stay and a higher mortality rate, but were also more severely ill, as manifested by higher simplified acute physiology score (SAPS) II and sequential organ failure assessment (SOFA) scores than the other patients. A Cox proportional hazard model indicated that albumin administration was significantly associated with decreased 30-day survival. Moreover, in 339 pairs matched according to a propensity score, ICU and hospital mortality rates were higher in the patients who had received albumin than in those who had not (34.8 versus 20.9% and 41.3 versus 27.7%, respectively, both p < 0.001).

Conclusion

Albumin administration was associated with decreased survival in this population of acutely ill patients. Further prospective randomized controlled trials are needed to examine the effects of albumin administration in sub-groups of acutely ill patients.