Table1_Impact of albumin infusion on prognosis in ICU patients with cirrhosis and AKI: insights from the MIMIC-IV database.docx

BackgroundAcute kidney injury (AKI) is common in cirrhotic patients, especially in the intensive care unit (ICU), and is often associated with poor prognosis. Albumin is often used for plasma volume expansion, but its efficacy in cirrhotic patients with AKI [excluding hepatorenal syndrome (HRS)] is debated. This study aimed to assess the impact of albumin therapy on prognosis in ICU patients with cirrhosis and non-HRS AKI.
MethodsA retrospective analysis was conducted using the MIMIC-IV 2.2 database. The primary endpoint was 28-day mortality. Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics between the albumin and non-albumin groups.
ResultsA total of 1,623 patients were included, with 586 receiving albumin. After IPTW, the sample sizes were 1,713 in the non-albumin group and 1,490 in the albumin group. Albumin administration was associated with higher rates of AKI recovery at 48 h but did not improve 28-day mortality in the overall cohort. Further analysis revealed that using 5% albumin concentration was associated with improved 28-day mortality (HR 0.68; 95% CI 0.49–0.95; p = 0.025), whereas 25% albumin did not show benefit. In patients with high bilirubin levels, albumin treatment significantly reduced 28-day mortality. However, albumin therapy may increase 28-day mortality in certain subgroups, including patients with chronic kidney disease and baseline albumin levels >3.3 g/dL.
ConclusionAlthough albumin therapy improved 28-day mortality in some cases, it may also increase mortality in certain subgroups. The use of albumin in critically ill patients with cirrhosis and AKI should be approached with greater consideration of its risks and benefits.

背景：急性肾损伤（Acute Kidney Injury, AKI）在肝硬化患者中较为常见，尤以重症监护病房（Intensive Care Unit, ICU）患者高发，且常与不良预后相关。白蛋白常被用于血浆容量扩张，但在合并AKI（不包括肝肾综合征（Hepatorenal Syndrome, HRS））的肝硬化患者中，其疗效尚存争议。本研究旨在评估白蛋白治疗对合并肝硬化与非HRS型AKI的ICU患者预后的影响。
方法：本研究采用MIMIC-IV 2.2数据库开展回顾性分析。主要结局指标为28天死亡率。采用治疗逆概率加权（Inverse Probability of Treatment Weighting, IPTW）平衡白蛋白组与非白蛋白组的基线特征。
结果：共计纳入1623例患者，其中586例接受白蛋白治疗。经IPTW平衡后，非白蛋白组样本量为1713例，白蛋白组为1490例。白蛋白给药与48小时内AKI恢复率升高相关，但在全队列中未改善28天死亡率。进一步分析显示，使用5%浓度白蛋白与28天死亡率改善相关（风险比（Hazard Ratio, HR）0.68；95%置信区间（Confidence Interval, CI）0.49–0.95；p=0.025），而25%浓度白蛋白未显示获益。在高胆红素血症患者中，白蛋白治疗可显著降低28天死亡率。然而，白蛋白治疗可能在部分亚组中升高28天死亡率，包括合并慢性肾病以及基线白蛋白水平＞3.3g/dL的患者。
结论：尽管白蛋白治疗在部分情况下可改善28天死亡率，但在特定亚组中也可能升高死亡率。对于合并肝硬化与AKI的重症患者，使用白蛋白时应更审慎地权衡其获益与风险。