2964 Real World Evidence Demonstrates a Difference in the Presenting Characteristics of Cirrhotic Patients Who Received Albumin Compared to Those Who Received Only Crystalloids

Abstract

INTRODUCTION: Cirrhosis affects over 633,000 adults in the US with recent mortality rates increasing by 3.4% annually. Readmission rates have also been shown to be high. These patients may be resuscitated with albumin, crystalloids, or both. METHODS: This study used real-world data to examine differences in the burden of disease among adults admitted with cirrhosis who were treated with albumin (<24 hours (early) versus >24 hours (late) after admission) versus crystalloids alone, between January 1, 2009, and December 31, 2016. We used a nationwide Electronic Health Record database (Cerner Health Facts®) and compared Model for End-stage Liver Disease Sodium (MELD-Na) score and Elixhauser Comorbidity Index across the fluid resuscitation groups. RESULTS: We identified 86,432 patients admitted with cirrhosis. The mean age was 59.2 years and the majority (55.4%) were male. Patients who received albumin (n = 26,835) had higher MELD-Na scores at presentation (mean score 22.0 in patients treated early and mean score 19.5 in patients treated late), versus patients who received only crystalloids (n = 59,597; mean score 14.1). Additionally, at presentation, patients who received albumin had a higher Elixhauser Comorbidity Index (mean 18.8 and 19.9 in patients receiving albumin early versus late respectively) versus patients who received crystalloids alone (mean 16.3). CONCLUSION: Cirrhotic patients who were treated with albumin had, at presentation, a higher MELD-Na score and Elixhauser Index, which represents a greater burden of disease compared to patients treated with only crystalloids. Further research is needed to examine differences in clinical and economic outcomes, including complications of cirrhosis such as acute kidney injury, spontaneous bacterial peritonitis, ascites, and procedures of large volume paracentesis, following different fluid resuscitation regimens.