INTRODUCTION:Cirrhosis is the end stage of any condition in which the liver progressively becomes scarred. It is a common cause of increased risks of morbidity, mortality, and hospital readmission. Albumin plays a critical role in the management of decompensated cirrhosis and end-stage liver disease. Using real-world evidence from a multi-hospital U.S health database, we assessed the association between albumin infusion timing and in-hospital mortality among cirrhotic patients. METHODS:We utilized a de-identified, nationwide chargemaster dataset (Premier) and extracted information on adult patients (≥18 years old) hospitalized with cirrhosis, between January 1, 2016 and June 30, 2019. We defined baseline Elixhauser Comorbidity Index (ECI) using van Walraven weighting algorithm. Our exposure groups were: 'timely albumin' defined as infusion ≤1 day of hospital admission and 'non-timely albumin' defined as infusion >1 day of admission or no albumin at all. Logistic regression models were used to determine the association between timely albumin and in-hospital mortality after 1:1 propensity score matching (PSM); adjusting for patient and hospital characteristics, ECI, and presence of hepatorenal syndrome, end-stage renal disease, and ascites at baseline. RESULTS:The initial selection criteria identified 921,692 adult inpatient hospitalizations. Out of these, 490,006 remained after excluding for missing hospital/patient data, liver transplant, and insufficient or no fluid resuscitation. After 1:1 matching, a total of 109,674 inpatient hospitalizations were analyzed. A risk-adjusted analysis showed the timely albumin group to be associated with a 16% reduction in in-hospital mortality when compared to the non-timely group (OR: 0.84; 95% CI: 0.81 -0.89; p< 0.001).CONCLUSIONS: Timely albumin in cirrhotic patients was associated with lower in-hospital mortality. These data suggest that timely albumin use in cirrhosis, as per general guideline recommendations, may improve health outcomes. Albumin may be administered to a wider patient population for potentially greater benefits, rather than reserving it only for worsened prognoses due to perceived higher costs.

INTRODUCTION:Cirrhosis is the end stage of any condition in which the liver progressively becomes scarred. It is a common cause of increased risks of morbidity, mortality, and hospital readmission. Albumin plays a critical role in the management of decompensated cirrhosis and end-stage liver disease. Using real-world evidence from a multi-hospital U.S health database, we assessed the association between albumin infusion timing and in-hospital mortality among cirrhotic patients. METHODS:We utilized a de-identified, nationwide chargemaster dataset (Premier) and extracted information on adult patients (≥18 years old) hospitalized with cirrhosis, between January 1, 2016 and June 30, 2019. We defined baseline Elixhauser Comorbidity Index (ECI) using van Walraven weighting algorithm. Our exposure groups were: 'timely albumin' defined as infusion ≤1 day of hospital admission and 'non-timely albumin' defined as infusion >1 day of admission or no albumin at all. Logistic regression models were used to determine the association between timely albumin and in-hospital mortality after 1:1 propensity score matching (PSM); adjusting for patient and hospital characteristics, ECI, and presence of hepatorenal syndrome, end-stage renal disease, and ascites at baseline. RESULTS:The initial selection criteria identified 921,692 adult inpatient hospitalizations. Out of these, 490,006 remained after excluding for missing hospital/patient data, liver transplant, and insufficient or no fluid resuscitation. After 1:1 matching, a total of 109,674 inpatient hospitalizations were analyzed. A risk-adjusted analysis showed the timely albumin group to be associated with a 16% reduction in in-hospital mortality when compared to the non-timely group (OR: 0.84; 95% CI: 0.81 -0.89; p< 0.001).CONCLUSIONS: Timely albumin in cirrhotic patients was associated with lower in-hospital mortality. These data suggest that timely albumin use in cirrhosis, as per general guideline recommendations, may improve health outcomes. Albumin may be administered to a wider patient population for potentially greater benefits, rather than reserving it only for worsened prognoses due to perceived higher costs.

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