Use of albumin as a risk factor for hospital mortality among burn patients in Brazil
non-concurrent cohort study
Keywords:
Serum albumin, Burns, Mortality, Inpatients, Cohort studiesAbstract
CONTEXT AND OBJECTIVE: Among burn patients, it is common to use colloidal substances under the justification that it is necessary to correct the oncotic pressure of the plasma, thereby reducing the edema in the burnt area and the hypotension. The aim here was to assess the risk of hospital mortality, comparing the use of albumin and crystalloid solutions for these patients. DESIGN AND SETTING: Non-concurrent historical cohort study at Faculdade de Medicina de Marília; within the Postgraduate program on Internal and Therapeutic Medicine, Universidade Federal de São Paulo; and at the Brazilian Cochrane Center. METHODS: Burn patients hospitalized between 2000 and 2001, with registration in the Hospital Information System, who received albumin, were compared with those who received other types of volume replacement. The primary outcome was the hospital mortality rate. The data were collected from files within the Datasus software. RESULTS: 39,684 patients were included: 24,116 patients with moderate burns and 15,566 patients with major burns. Among the men treated with albumin, the odds ratio for the risk of death was 20.58 (95% confidence interval, CI: 11.28-37.54) for moderate burns and 6.24 (CI 5.22-7.45) for major burns. Among the women, this risk was 40.97 for moderate burns (CI 21.71-77.30) and 7.35 for major burns (CI 5.99-9.01). The strength of the association between the use of albumin and the risk of death was maintained for the other characteristics studied, with statistical significance. CONCLUSION: The use of albumin among patients with moderate and major burns was associated with considerably increased mortality.
Downloads
References
Gomes DR, Cabral MD. Avaliação pré-hospitalar. In: Gomes DR, Serra MCVF, Pellon MA, editores. Queimaduras. Rio de Janeiro: Revinter; 1995. p. 9-14.
Gomes DR. Fisiologia e fisiopatologia. In: Gomes DR, Serra MCVF, Pellon MA, editores. Quei- maduras. Rio de Janeiro: Revinter; 1995. p. 15-28.
Brasil. Ministério da Saúde. Gabinete do Ministro. Portaria nº 1.273/GM de 21 de novem- bro de 2000. Cria mecanismos para a organização e implantação de Redes Estaduais de Assistência a Queimados. Diário Oficial da União, Brasília. 2000; nov. 23. Seção I. Available from: http://dtr2001.saude.gov.br/sas/PORTARIAS/PORT2000/GM/GM-1273.htm. Accessed in 2010 (Aug 10).
Brasil. Ministério da Saúde. Gabinete do Ministro. Portaria nº 1274/GM, de 22 de no- vembro de 2000. Adota para fins de enquadramento nos procedimentos do Sistema de Informações Hospitalares SIH-SUS incluídos na Tabela por esta Portaria, a seguinte classi- ficação de grau de extensão e gravidade de queimaduras. Diário Oficial da União, Brasilia. 2001; fev. 26. Seção I, p. 67 a 71. Available from: http://dtr2001.saude.gov.br/sas/PORTARIAS/PORT2000/GM/GM-1274rp.htm. Accessed in 2010 (Aug 10).
Choi PT, Yip G, Quinonez LG, Cook DJ. Crystalloids vs. colloids in fluid resuscitation: a systematic review. Crit Care Med. 1999;27(1):200-10.
Bunn F, Roberts I, Tasker R, Akpa E. Hypertonic versus near isotonic crystalloid for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2004;(3):CD002045.
Alderson P, Bunn F, Lefebvre C, et al. Human albumin solution for resuscitation and volume expansion in critically ill patients. Cochrane Database Syst Rev. 2004(4):CD001208.
Escosteguy CC, Portela MC, Medronho R de A, Vasconcellos MT. AIH versus prontuário mé- dico no estudo de risco de óbito hospitalar no infarto agudo do miocárdio no Município do Rio de Janeiro, Brasil [Hospital admissions forms versus medical records to assess risk of in-hospital death from acute myocardial infarction in Rio de Janeiro, Brazil]. Cad Saude Publica. 2005;21(4):1065-76.
Matos GC, Rozenfeld S. Avaliação do uso de albumina humana em hospital do Rio de Ja- neiro, Brasil [Evaluation of human albumin use in a Brazilian hospital]. Cad Saude Publica. 2005;21(4):1224-33.
Wilkes MM, Navickis RJ. Patient survival after human albumin administration. A meta-analy- sis of randomized, controlled trials. Ann Intern Med. 2001;135(3):149-64.
Vincent JL, Navickis RJ, Wilkes MM. Morbidity in hospitalized patients receiving human albu- min: a meta-analysis of randomized, controlled trials. Crit Care Med. 2004;(10):2029-38.
Finfer S, Bellomo R, Boyce N, et al. A comparison of albumin and saline for fluid resuscita- tion in the intensive care unit. N Engl J Med. 2004;350(22):2247-56.
Pulimood TB, Park GR. Debate: Albumin administration should be avoided in the critically ill. Crit Care. 2000;4(3):151-5.
