552 - Evaluation of Albumin Plus Furosemide Versus Furosemide Alone in Pediatric Critical Illness

Publication Number: 4540.552

Kaleb Dobbs, University of South Dakota Sanford School of Medicine - - Vermillion, SD, Sioux Falls, SD, United States; Samuel Hagman, University of South Dakota, Sanford School of Medicine, birmingham, AL, United States; Gokhan Olgun, University of South Dakota, Sanford School of Medicine, Sioux Falls, SD, United States

Background: Fluid overload is a major determinant of morbidity in critically ill children. Clinicians often co-administer 25% albumin with furosemide to augment diuresis by expanding intravascular volume and enhancing drug delivery to the nephron, but supporting evidence remains limited.

Objective: To evaluate whether albumin–furosemide combination therapy increases urine output at 6 hours compared to furosemide alone in critically ill pediatric patients.

Design/Methods: We conducted a retrospective cohort study of PICU patients (0–18 years) admitted to a tertiary children’s hospital from 2016–2023. Patients receiving intravenous furosemide alone were compared with those receiving 25% albumin followed by furosemide. Exclusion criteria included nephrotic syndrome, protein-losing enteropathy, cirrhosis/ascites, and sulfa allergy. The primary outcome was urine output at 6 hours. Independent-samples t tests compared group means. Linear regression assessed predictors of urine output, including pediatric SOFA (pSOFA) score and treatment allocation. The study protocol was approved by the Sanford Health institutional review board.

Results: Eighty-three patient encounters met criteria. Urine output at 6 hours did not differ significantly between the albumin-plus-furosemide and furosemide-only groups (t(81)=0.79, p=0.434). On regression analysis, higher pSOFA scores independently predicted reduced urine output (β=−41.6 mL per point, p=0.017). Albumin–furosemide co-administration was not associated with improved output (β=+38.6 mL, p=0.762).

Conclusion(s): Albumin added to furosemide did not enhance diuretic response in this single-center pediatric cohort. These findings do not support routine use of combination therapy in unselected critically ill children and suggest that illness severity (pSOFA) may be a more relevant predictor of diuretic responsiveness. Future prospective studies are needed to confirm these results and to identify whether specific patient subgroups, such as those with hypoalbuminemia or refractory fluid overload, might benefit from adjunctive albumin therapy.