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Albumin Replacement in Patients With Severe Sepsis or Septic Shock
Study Questions:
What are the effects of the administration of albumin and crystalloids (targeting a serum albumin level of 30 g/L or more), compared to crystalloids alone, in patients with severe sepsis?
Methods:
The ALBIOS (Albumin Italian Outcome Sepsis) study was a multicenter, open-label, randomized, controlled trial performed in 100 intensive care units (ICUs) in Italy. Patients with severe sepsis were randomized to receive either 20% albumin and crystalloid solution or crystalloid solution alone. The primary outcome measure was death from any cause at 28 days after randomization.
Results:
After 28 days of randomization, 285 of 895 patients (31.8%) in the albumin group and 288 of 900 (32.0%) in the crystalloid group had died (relative risk in the albumin group, 1.00; 95% confidence interval [CI], 0.87-1.14; p = 0.94). In a post-hoc analysis of patients with septic shock, there was a significant reduction in death (relative risk without septic shock, 0.87; 95% CI, 0.77-0.99). There were no significant differences between groups for secondary safety outcomes.
Conclusions:
In patients with severe sepsis, albumin replacement in addition to crystalloids, compared to crystalloids alone, was safe, but did not improve survival.
Perspective:
The authors provide convincing evidence against the routine use of a strategy of albumin replacement in addition to crystalloid solution in patients with severe sepsis. That said, there may be a minority of patients who do benefit, as a post-hoc analysis did demonstrate improved survival in those patients with shock who received albumin and crystalloid. This finding certainly warrants further investigation.
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