Background and importance Human serum albumin (HSA) is widely used in clinical practice, although many indications are still being debated.
Aim and objectives To analyse the clinical indications for HSA and the level of evidence for them.
Material and methods This was an observational, retrospective, multidisciplinary study. Inclusion criteria were: patients >18 years admitted, patients treated in a specialised outpatient clinic or emergency department, in a secondary hospital, who had received at least one dose of HSA during 2019. Variables studied were: demographics, admission diagnosis, number of HSA prescriptions, duration of treatment, previous serum albumin, previous infection, HSA indication and level of evidence of the indications.
The classification was based on the scale established by the American Society of Apheresis, which categorises four groups according to the degree of evidence:
High priority (grade I): paracentesis induced circulatory dysfunction (PICD) after large volume paracentesis (>5 L); hepatorenal syndrome, renal failure after spontaneous bacterial peritonitis (SBP) and plasmapheresis.
Reasonable evidence, but with available alternatives (grade II): resuscitation in critically ill patients with septic shock when crystalloids are insufficient.
Weak evidence (grade III): hypervolaemic hyponatraemia in decompensated cirrhosis, awaiting liver transplantation, non–SBP bacterial infections in cirrhotic patients, prevention of PICD <5 L.
Treatment not recommended (grade IV): other indications.
Results The study included 142 patients, 41% women, mean age 66±11 years. The main admission diagnoses were: decompensated cirrhosis (32%), septic shock (31%), haemorrhagic shock (5%) and respiratory infection (4%). They received a total of 223 batches of HSA. The median duration of prescription was 3 days (IQR 2–4). The mean basal plasma albumin was 2.5±0.5 mg/dL. 48% had a previous active infection. The major indications of HSA were: anasarca and hypoalbuminaemia (32%), prevention of PICD >5 L (17%), resuscitation in shock septic (13%) and protein malnutrition (9%). 26% of the indications had grade I evidence, 13% grade II, 9% grade III and 53% grade IV.
Conclusion and relevance There is an important use for HSA in hospitals with a low level of evidence. It is necessary to train prescribing doctors to optimise the use of HSA in hospital.
Conflict of interest No conflict of interest
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