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?


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.


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.


In patients with severe sepsis, albumin replacement in addition to crystalloids, compared to crystalloids alone, was safe, but did not improve survival.


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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