potential ). The authors concluded that as patients with sepsis suffer from oxidative stress , albumin administration may represent an important aspect of clinical care . 14 The Albumin Italian Outcome Sepsis ( ALBIOS ) trial , a multicenter , open-label RCT on 1818 patients with severe sepsis or septic shock enrolled from 100 Italian ICUs , examined the benefit of albumin replacement . 15 Patients were randomized to receive either 20 % albumin and crystalloids or crystalloids alone during the first phase of volume replacement . The target serum albumin concentration was 30g / l or more until discharge from ICU or 28 days after randomization . The primary outcome was death from any cause after 28 days and secondary outcomes were death from any cause at 90 days , the number of patients with organ dysfunction , the degree of dysfunction , and length of stay in the ICU and the hospital . During the first 7 days , patients in the albumin group , showed a higher mean arterial pressure ( p = 0.03 ) and lower net fluid balance ( p < 0.001 ) although the total daily amount of administered fluid did not differ significantly between the two groups ( p = 0.10 ). However , there were no significant differences in mortality between albumin or crystalloid treatment at day 28 ( 31.8 % vs 32 %) or at day 90 ( 41.1 % vs 43.6 %). Nonetheless , in a post-hoc analysis of the ALBIOS study , patients with septic shock receiving albumin administration showed a significant 6.3 % absolute reduction in 90-day mortality as compared with those receiving only crystalloids . 16
The efficacy of 4 % albumin administration during the early phase of sepsis has also been compared with lactated Ringer ’ s in a total of 360 patients with cancer . After 7 days , there was no difference in survival between the two groups ( 26 % vs . 22 %, albumin vs lactated Ringer ’ s , p = 0.5 ). 17 In a retrospective comparative study of 5 % albumin plus saline or saline alone for large volume resuscitation in 16,201 patients , Gomez et al 18 found that use of albumin was associated with a lower 30-day mortality ( odds ratio , OR = 0.65 , 95 % CI 0.49 – 0.85 , p = 0.002 ) and although there was a higher incidence of acute kidney injury , this did not lead to renal dysfunction or need for dialysis .
Despite a clear rationale for use in critically ill patients , an updated Cochrane meta-analysis in 2018 on the use of either crystalloid and colloid solutions concluded that the use of either starches , dextrans or albumin compared with crystalloids , made little or no difference to mortality . 19 Once again , when considering morbidity as opposed to mortality as an endpoint , a 2019 meta-analysis of studies with more than 27,000 critically ill patients , examining the effect of either crystalloids or colloids on hemodynamics , concluded that albumin appeared to be associated with a higher mean arterial and central venous pressure , and more adequate cardiac index . 20 In fact , in a reply to the ensuing correspondence about their metaanalysis , the authors suggested that “ albumin should be more widely considered as an alternative to crystalloids in the ICU and that more evidence needs to be generated in order to make definitive recommendations .” 21
These findings do not reject the hypothesis that the oncotic properties of human albumin may have beneficial effects in specific categories
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