Authors
Pokhabov D.S., Shestakov E.A., Gusarov V.G., Fedyk O.V., Zhiburt E.B.
Pirogov National Medical and Surgical Center, Moscow
Abstract
Rationale: Albumin is one of the most important proteins, playing a significant role in maintaining colloid osmotic pressure, wound healing, reducing oxidative damage, transport of drugs and endogenous substances, and coagulation.
Objective: To identify patterns of albumin infusions in a multidisciplinary hospital, to assess the compliance of albumin use with the standards of medical care.
Methods: Retrospectively, based on materials from 43,710 electronic medical records, the infusion of albumin solution to hospital patients at the Pirogov Center in 2023 was studied. Infusions of 25% albumin solution in 50 ml bottles (Kedrion, Italy) were performed. The data were studied using descriptive and inductive statistics, analysis of variance ANOVA at a significance level of 0.05.
Results: 146 people (0.3%) received albumin infusions. In total, patients received 2466 vials of albumin, or an average of approximately 211 grams of albumin per patient. There were 5 groups of albumin recipients: 1) cardiac surgery (n = 45); 2) oncohematology (n = 14); 3) oncology (n = 35); 4) trauma/orthopedics (n = 16); 5) other (n = 36). There were no gender differences in albumin recipients in terms of age, duration of treatment, mortality, volume or regimen of albumin administration. In the selected groups of patients, significant differences in age were revealed. Minimum age – in the oncohematology group: median (quartiles) – 43 (35; 52) years, maximum age – in the oncology group: 67 (59; 73) years (p<0.001). The groups also differed in terms of hospital treatment: minimum – in the cardiac surgery group: median (quartiles) – 13 (9; 17) days, maximum – in the group of other diseases: 22 (15; 35) days (p<0.001) and in intensive care: minimum – in the cardiac surgery group: median (quartiles) – 4 (3; 7) days, maximum – in the group of other diseases: 6.5 (4; 20) days (p<0.001). Body weight is known in 7 patients of the Pirogov Center with a minimum albumin concentration in 2023 (from 11.6 g/l to 18.4 g/l). If we apply a target albumin concentration of 30 g/l, then the prescribed dose of the drug will range from 35.4 g to 91.7 g.
Conclusion: At the Pirogov Center, a 25% albumin solution is administered for replacement purposes, focusing on the target concentration of albumin in the patient’s serum of about 30 g/l. The dosage and duration of albumin administration differs in different groups of patients: the minimum amount of albumin was received by patients in the cardiac surgery group: median (quartiles) – 75 (37.5; 122.5) grams for 2 (1; 3) days, the maximum – by patients in the other group diseases: 110 (62.5; 337.5) grams for 3 (1; 6) days (p = 0.009 and p = 0.012, respectively).
It is advisable:
a) make changes to 11 standards of medical care regulating the dose of albumin in milliliters, without indicating the concentration of the solution;
b) to clarify the possibly overestimated average daily dose of albumin of 100 grams, determined by 4 standards of medical care for cardiac surgery patients.
Keywords: albumin, infusion, indications, dosage, concentration, standard, evidence-based medicine.
References
1. Shevchenko YL, Karpov OE, Zhiburt EB. Blood transfusion: history and modernity (on the 100th anniversary of blood transfusion in Russia). Vestnik Nacional’nogo mediko-hirurgicheskogo centra im. N.I. Pirogova. 2019; 14(4): 4-11. (In Russ.) doi: 10.25881/ BPNMSC.2020.29.78.001.
2. Zhiburt EB. Patient blood management for critical bleeding and massive transfusion. Vestnik Nacional’nogo mediko-hirurgicheskogo centra im. N.I. Pirogova. 2013; 8(4): 71-77. (In Russ.)
3. Shevchenko YL, Zhiburt EB, Shestakov EA. The implementation of a blood-saving ideology in the practice of the Pirogov Center. Vestnik Nacional’nogo mediko-hirurgicheskogo centra im. N.I.Pirogova. 2008; 3(1): 14-21. (In Russ.)
4. Zhiburt EB. Pirogov center blood service: yesterday, today, tomorrow. Vestnik Nacional’nogo mediko-hirurgicheskogo centra im. N.I. Pirogova. 2006; 1(1): 55-57. (In Russ.)
5. Hanley C, Callum J, McCluskey S, Karkouti K, Bartoszko J. Albumin use in bleeding cardiac surgical patients and associated patient outcomes. Can J Anaesth. 2021 Oct; 68(10): 1514-1526. doi: 10.1007/s12630-021-02070-7.
6. Wiedermann CJ. Phases of fluid management and the roles of human albumin solution in perioperative and critically ill patients. Curr Med Res Opin. 2020; 36(12): 1961-1973. doi: 10.1080/03007995.2020.1840970.
7. Gabarre P, Desnos C, Morin A, et al. Albumin versus saline infusion for sepsis-related peripheral tissue hypoperfusion: a proof-of-concept prospective study. Crit Care. 2024; 28(1): 43. doi: 10.1186/s13054-024-04827-0.
8. Wiedermann CJ. Hypoalbuminemia as Surrogate and Culprit of Infections. Int J Mol Sci. 2021; 22(9): 4496. doi: 10.3390/ijms22094496.
9. Maslakov KD. Economic reserve for normalizing the structure of consumption of hemoproducts. Journal of the Grodno State Medical University. 2010; 3(31): 92-94. (In Russ.)
10. Fedostina EA, Mayevskaya MV, Ivashkin VT. Diagnosis and treatment of complications of liver cirrhosis. Pharmateka. 2012; S1: 7-18. (In Russ.)
11. Aleksandrov VA, Arkhipov VV, Bagnenko SF, et al. Directory of ambulance and emergency medical care doctors. Sixth edition, revised and expanded. St. Petersburg: Polytechnics, 2007. (In Russ.)
12. China L, Freemantle N, Forrest E, et al. A Randomized Trial of Albumin Infusions in Hospitalized Patients with Cirrhosis. N Engl J Med. 2021; 384(9): 808-817. doi: 10.1056/NEJMoa2022166.
13. Pesonen E, Vlasov H, Suojaranta R, et al. Effect of 4% Albumin Solution vs Ringer Acetate on Major Adverse Events in Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass: A Randomized Clinical Trial. JAMA. 2022; 328(3): 251-258. doi: 10.1001/jama.2022.10461.
14. Albumin Human Dosage. [URL].
