Abstract
Human serum albumin (HSA) possesses oncotic, antioxidant, and immunomodulatory properties. Although recent studies suggest that albumin may promote resolution of acute-on-chronic liver failure (ACLF) and reduce the incidence of infection, its impact on overall prognosis with daily administration remains unestablished. Patients meeting the Asian Pacific Association for the Study of the Liver (APASL) criteria for ACLF were extracted from the Medical Information Mart for Intensive Care (MIMIC-IV 2.2) database. The primary outcome was 30-day mortality. To balance baseline characteristics between the albumin and non-albumin groups, we applied stabilized inverse probability of treatment weighting (SIPTW). The association between daily albumin infusion and 30-day mortality was subsequently assessed using Cox regression analyses. A total of 505 patients were enrolled in the study, of whom 325 received albumin therapy within the first 24 h of ICU admission. After applying SIPTW, the cohort comprised 169 patients in the non-albumin group and 319 in the albumin group. Overall, albumin administration was not significantly associated with 30-day mortality in patients with ACLF. However, subgroup analyses revealed that albumin infusion conferred the most substantial survival benefit in specific patient populations. These included individuals with spontaneous bacterial peritonitis, a Model for End-Stage Liver Disease score of ≥ 30.1, a mean arterial pressure below 73 mmHg, a daily albumin dosage of ≤ 1.0 g/kg, or those receiving a combination of 5% and 25% albumin concentrations. Conversely, a dosage exceeding 1.0 g/kg/day was associated with inferior 30-day survival. Albumin administration is associated with reduced mortality in specific subpopulations of patients with ACLF. Key clinical parameters-including serum albumin concentration, SBP, MELD score, and MAP-were identified as significant modifiers of treatment efficacy and should be incorporated into clinical decision-making when initiating albumin therapy.