OBJECTIVES: SBP is a serious and costly cirrhosis complication, with ~50% of cases requiring ICU admission. Due to its demonstrated efficacy in critical care settings, albumin is recommended by the American Association for the Study of Liver Diseases as an adjuvant to antibiotics for the management of SBP. We examined the relationship between early albumin infusion and ICU cost in a subgroup of cirrhotic patients who developed SBP during hospitalization.

METHODS: Premier Healthcare Database was queried for inpatient data corresponding to adult cirrhotic patients who developed SBP, received antibiotics, and experienced an ICU admission/transfer, between Jan-2016 and Jun-2019. Patients were selected based on ICD-10 and billing codes. The ‘early albumin’ group included patients who received albumin within 1 day of hospitalization, while the ‘non-early’ group received albumin after day 1 of hospitalization or not at all. Propensity score matching (PSM) (1:1) was used to balance both cohorts by sociodemographic characteristics, baseline Elixhauser Comorbidity Index, and presence of hepatorenal syndrome, end-stage renal disease, and ascites. Generalized linear models were employed to determine the association between early albumin and ICU costs, controlling for common comorbidities (e.g., hepatic encephalopathy).

RESULTS: PSM yielded 4,106 patients of whom 2,632 survived to discharge. The risk-adjusted ICU cost ratio (CR) was 11% lower among all patients who received early albumin compared to the non-early group (CR: 0.89, 95% CI: 0.84-0.93, p<0.001). In the survivor cohort, the risk-adjusted ICU CR was 18% lower in the early group relative to the non-early group (CR: 0.82, 95% CI: 0.77-0.88, p<0.001).

CONCLUSIONS: Early albumin infusion was associated with a significant ICU cost reduction in both the overall and survivor-only cohorts. These findings suggest that the co-administration of albumin with antibiotics may alleviate the growing ICU cost burden of SBP as a complication of cirrhosis.