1060 The Use of Albumin in Cirrhotics: Data From a Tertiary Care Center

Abstract

INTRODUCTION: Human albumin solution is an expensive colloid preparation commonly used in cirrhotics’ management. Approved indications of albumin administration in cirrhotics include large volume paracentesis (LVP), hepatorenal syndrome (HRS), and spontaneous bacterial peritonitis (SBP). Albumin use is not routinely recommended in inflammatory and hypovolemic states. The aim of this study is to identify albumin utilization patterns in a tertiary care center and to assess potential areas of improvement in albumin prescribing strategies. METHODS: We performed a retrospective chart review of 342 cirrhotic patients who received 25% albumin solution during their admission from January 2016 to January 2018. Baseline demographics, etiology of cirrhosis, and severity was noted. Indications for albumin administration were reviewed and other clinical variables were gathered. Patients with and without indications for albumin were compared using chi-square tests for categorical variables and two-sample t-tests for continuous variables. RESULTS: There were 342 cirrhotic patients included in this study. 187 (55%) were male, 227 (66%) were Caucasian and the mean age was 59 ± 11 years. The most common cirrhotic etiologies were Alcohol (n = 95, 28%), Nonalcoholic steatohepatitis (NASH) (n = 84, 25%) and Hepatitis C (n = 72, 21%). There were 187 (55%) patients who had at least one approved indication for albumin; out of those patients, 167 (48.4%) had HRS, 66 (19%) had SBP, and 77 (23%) underwent LVP. African Americans were more likely to receive albumin in the absence of an indication, as compared to Caucasians (P = 0.047). Patients who received albumin without an indication had a higher incidence of septic shock (34% vs 21%, P = 0.008); sepsis with acute kidney injury (AKI) (22% vs 12% P = 0.017); and history of HRS (35% vs 19% P = 0.0005) or SBP (37% vs 25% P = 0.018). No differences were detected between the two groups for age, gender, BMI, MELD, MELD NA, and etiology. CONCLUSION: There is a high rate of non-indicated albumin administration in cirrhotic patients. Apart from approved indications which have mortality benefit, shock, hypovolemia, or a history of SBP/HRS are influencing physicians to use albumin in cirrhotics. It is important to establish clinical protocols for judicial use of this expensive and limited resource.