Effect of Hypoalbuminemia on Response to Loop Diuretics and Albumin in Patients with Acute Respiratory Distress Syndrome

ABSTRACT

Introduction: Conservative fluid management is a cornerstone of therapy for Acute Respiratory Distress Syndrome (ARDS). Existing studies of loop diuretics have had difficulty achieving goal urine output (UOP) and evaluations of adjunctive albumin have been limited by heterogeneous cohorts. Research Question or Hypothesis: Hypoalbuminemic patients with ARDS are more likely to exhibit a positive response to loop diuretics with adjunctive albumin than patients with normal serum albumin. Study Design: Single-center, retrospective observational study Methods: Adult patients were included if admitted to an intensive care unit (ICU) from January 2016 to September 2021 and received loop diuretic and albumin within one hour of each other. Exclusion criteria included liver failure, dialysis, pregnancy, trauma or positive test for SARS-COV-2. Patients were divided into two groups (low and normal) by baseline serum albumin, where low albumin was defined as ≤ 3.5g/dL. The primary outcome was the percentage of patients with a positive response to combination therapy, defined as UOP ≥ 600mL within six hours of the last agent being administered. Secondary outcomes included UOP at six hours and change in body weight, oxygenation, and serum albumin at 24 hours. Chi-squared and Mann- Whitney U tests were used for nominal and continuous variables, respectively with alpha <0.05 used to determine significance. Results: 102 patients were in the low-albumin group and 73 in the normal-albumin group. 61 (56%) were positive responders in the lowalbumin group, compared to 43 (64%) in the normal-albumin group (p=0.313). Patients in low-albumin group had a greater change in serum albumin (p<0.001) at 24 hours. No other secondary outcomes were statistically significant. Conclusion: Patients with low albumin were no more likely to have a positive response to adjunctive albumin therapy with loop diuretics than patients with normal albumin. Heterogeneity of administration exist and should be further explored.