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

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. ObjectivesThe 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. MethodsRetrospective, 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. ResultsThe 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. ConclusionsA 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.