Timely Albumin Improves Survival in Patients With Cirrhosis on Diuretic Therapy Who Develop Acute Kidney Injury: Real-World Evidence in the United States

Background and Aims: Patients admitted with decompensated cirrhosis who develop acute kidney injury (AKI) tend to experience poor outcomes, even if provided with increased organ support such as renal replacement therapies. We assessed the association of albumin administered ≤24 hours of admission with hospital length of stay (LOS) and in-hospital mortality. Methods: The Cerner Health Facts Database was queried for hospitalized patients with cirrhosis who had >0.3 mg/dL increase in serum creatinine within 48 hours and received diuretics following admission between January 2009 and April 2018. This study received institutional review board exemption through federal regulation 45CFR46. Albumin infusion was “timely” if administered ≤24 hours after admission and “nontimely” if administered >24 hours after admission or not at all. Two subgroups were assessed: the AKILOS subgroup (patients who survived to discharge) and the AKIMORTALITY RISK subgroup (patients with the highest risk of mortality, ie, AKI stage 3). Results: A total of 4135 hospitalizations with cirrhosis and AKI were grouped into AKILOS (n = 3321) and AKIMORTALITY RISK (n = 609) subgroups. Albumin administration occurred in 59.7% of the AKILOS subgroup and 77.8% of the AKIMORTALITY RISK subgroup, but timely treatment only occurred in 25.9% and 35.8% of encounters within these subgroups, respectively. Risk-adjusted analysis showed timely albumin administration to be associated with a 15.5% reduction (P < .01) in LOS in the AKILOS subgroup and a 49% reduction in the odds of death (adjusted odds ratio: 0.51; P < .01) in the AKIMORTALITY RISK subgroup, when compared to the nontimely group. Conclusion: Among patients with cirrhosis and AKI, treatment with albumin ≤24 hours after admission was associated with a shorter LOS and lower risk of death in patients with stage 3 AKI.