Association of Early Albumin Administration with 28-Day in-Hospital Mortality in Septic Patients with Solid Malignant Neoplasms: A Retrospective Cohort Analysis of the MIMIC-IV Database

J Intensive Care Med. 2025 Dec 5:8850666251395595. doi: 10.1177/08850666251395595. Online ahead of print.

ABSTRACT

BackgroundPatients with malignant neoplasms exhibit an elevated risk of sepsis and associated mortality. For septic patients with hemodynamic instability, early albumin administration is recommended, yet its specific impact in cancer-related sepsis remains unclear. This study aims to explore the relationship between early albumin administration and prognostic outcomes in patients with solid malignant neoplasms complicated by sepsis.MethodsThis study employed a retrospective cohort analysis, utilizing data obtained from the Medical Information Mart for Intensive Care IV (MIMIC-IV v3.1) database. Patients were categorized into two groups: no-albumin and albumin. Within the albumin group, patients were further subclassified into early-albumin (infusion within 24 h of ICU admission) and late-albumin (infusion more than 24 h after ICU admission but before discharge). The primary endpoint was 28-day in-hospital mortality, while secondary endpoints including in-hospital mortality, length of hospital stay (Los_hospital), and length of ICU stay (Los_ICU).ResultsAmong 3700 eligible patients (2596 no-albumin; 1104 albumin), further subclassification within the albumin group revealed 736 early-albumin and 368 late-albumin patients. After propensity score matching (PSM), 312 pairs (early vs late) were analyzed. Cox regression models showed that early albumin administration significantly improved 28-day survival prospects. Compared to both no-albumin and late-albumin groups, the early-albumin group exhibited a pronounced survival advantage. Additionally, early albumin administration was associated with a shorter ICU stay. Subgroup analyses confirmed benefits across various demographics and clinical characteristics in the early-albumin group.ConclusionsEarly albumin administration within 24 h of ICU admission significantly decreases 28-day and in-hospital mortality and shortens ICU stay in septic patients with solid malignant neoplasms. Our findings suggest that early albumin administration should be integrated into personalized resuscitation strategies for this high-risk population and merit further prospective validation.

PMID:41348561 | DOI:10.1177/08850666251395595