The Infusion of Human Serum Albumin had no Benefit on Acute Pancreatitis Therapy: An Analysis of Patients in Two Observational Cohorts

Abstract Objective: Human serum albumin (HSA) infusion is a common administration in acute pancreatitis patients in the Intensive Care Unit (ICU), but its actual association with patients' outcomes has not been confirmed. The study was aimed to determine whether the in-hospital prognosis of ICU patients with acute pancreatitis could benefit from albumin infusion. Methods: 950 acute pancreatitis patients diagnosed in 2008-2019 were extracted from the MIMIC-IV database as our primary study cohort. The primary outcome was in-hospital mortality. We also performed an external validation with a cohort of 104 acute pancreatitis patients after PSM matching from the eICU database. Results: In MIMIC-IV, 228 acute pancreatitis patients received HSA infusion (Alb group) during their hospitalization, while 722 patients did not (non-Alb group). Patients in the Alb group presented a poorer survival curve than the non-Alb group, while this difference disappeared after PSM or IPTW matching (log-rank test: PSM: p = 0.660, IPTW: p = 0.760). After including covariates, no association was found between albumin infusion and patients' in-hospital mortality before and after matching (original cohort: HR: 1.00, 95% CI: 0.66–1.52, p = 0.998). HSA infusion also did not benefit patients' 28-day or ICU mortality, while it significantly prolonged their duration in hospital and ICU. In addition, the initial serum albumin levels, infections or the amount of total albumin infusion did not affect the conclusion. Finally, in the eICU cohort, albumin infusion was still not a beneficial prognostic factor on patients' in-hospital mortality ( p = 0.087). Conclusion: Intravenous albumin infusion could not benefit acute pancreatitis patients' in-hospital prognosis and possibly prolong the hospital or ICU duration.