Effect of Baseline Albumin on Diuretic Response in Patients with Ards Receiving Adjunctive Albumin

ABSTRACT

INTRODUCTION: Fluid stewardship is a pillar in the management of ARDS. Previous studies evaluating conservative fluid management had difficulty achieving daily fluid targets and evaluations of adjunctive albumin have found conflicting results. METHOD(S) This was a retrospective study conducted at a large community hospital. Patients were included if >17 years old, admitted to an ICU from January 2016 to September 2021, had a diagnosis of ARDS, and received loop diuretic and albumin within one hour of each other. Exclusion criteria included liver failure, ESRD, and positive test for SARSCOV- 2. Patients were divided into two groups by baseline serum albumin, where low albumin was defined as <= 3.5g/ dL. The primary outcome was the percentage of patients with a positive response to combination therapy, defined as UOP >= 600mL within 6 hours of administration. Secondary outcomes included UOP at 6 hours, and change in PF ratio and serum albumin at 24 hours. Nominal data are presented as percentage, whereas continuous variables are presented as median and were analyzed using Chi-square and Mann Whitney U tests, respectively. Alpha of < 0.05 was deemed statistically significant. RESULT(S) 108 patients were in the low-albumin (LA) group and 67 in the normal-albumin (NA) group. The NA group were statistically heavier (99 vs. 88kg), had higher total protein (7.2 vs. 5.1 g/dL), had diagnosis of sepsis (59 vs. 6%) and had less prior diuretic use (48 vs. 74%). Key baseline similarities included PF ratio (158 vs. 160, p=0.7), creatinine (1.22 vs. 1.20 mg/dL), and presence of shock (27 vs. 33%). Statistically, more patients in the NA group received 5% albumin, (63 vs. 34%), received less albumin (12.5 vs. 25 grams), and similar loop diuretic dose expressed as furosemide equivalents (40 vs. 40 mg). 43 (64%) were positive responders in the NA group compared to 61 (57%) in the LA group (p=0.48). UOP at 6 hours (670 vs. 653mL) and change in PF ratio at 24 hours (+23 vs. +13) were statistically similar. The change in albumin was different between the Normal and Low groups (-0.6 vs. +0.2 g/dL, p< 0.05). CONCLUSION(S) Low albumin did not affect the urinary response in patients with ARDS receiving albumin and loop diuretics. These findings are limited by heterogeneity in baseline characteristics and components of the intervention.