Use of human albumin solution in a secondary hospital: an observational, retrospective, cross-sectional study

Abstract

Human albumin solution (HAS) is a plasma-derived product used for a wide variety of clinical indications, although only some of these are supported by solid scientific evidence. Objectives The primary aim of this study was to analyze the level of evidence supporting the clinical indications for which HAS is used at a secondary care hospital. Secondary objectives were to evaluate dosing appropriateness and perform a subanalysis of the internal medicine department. Methods Retrospective, observational, multidisciplinary study of adults who received at least one dose of HAS during 2019. We analyzed sociodemographic, clinical, laboratory, and pharmacotherapy variables. The indications for which HAS was used were classified into the four evidence-based categories established by the American Society for Apheresis: high priority (category I), reasonable evidence (II), weak evidence (III), and treatment not recommended (IV). Clinical guideline recommendations were used to evaluate dosing appropriateness. Results The study population comprised 142 patients (41% women), mean (SD) age of 66 (14) years. The main admission diagnoses were decompensated cirrhosis (32%) and septic shock (31%). In total, 223 courses of HAS were prescribed. The main indications were treatment of anasarca and hypoalbuminemia (32%), prevention of paracentesis-induced circulatory dysfunction after large-volume paracentesis (17%), resuscitation in septic shock (13%), and treatment of protein malnutrition (9%). Just 26% of hospital-wide indications were supported by strong evidence (category I); 13% category II, 8% category III, and 53% category IV. In the internal medicine department, 36% of indications were in category I, 16% in category III, 48% in category IV. An appropriate dosing regimen was used in just four category I indications. Conclusions A large proportion of HAS indications at our hospital are supported by weak evidence. Training to promote the rational use of HAS is needed. Protocols and local clinical guidelines could help standardize and optimize its use.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study did not receive any funding

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics Committee/IRB of Hospital General de Granollers, Spain gave ethical approval for this work (Reference number: 20204012).

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Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

Yes

Data Availability

All data produced in the present study are available upon reasonable request to the authors

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