Inclusion of Albumin in the Initial Resuscitation of Adult Patients with Medical Sepsis or Septic Shock: A Propensity Score Matched Analysis.

Abstract

INTRODUCTION\nThe impact of albumin resuscitation on sepsis outcomes is debated, particularly in the initial phase of resuscitation. We aimed to investigate the association between albumin use in the initial six hours of resuscitation and subsequent outcomes in adult septic patients.\n\n\nMETHODS\nThis single-center, retrospective, propensity score-matched cohort study included adult patients admitted to intensive care units (ICUs) with sepsis or septic shock from January 1, 2006, to May 4, 2018, at a tertiary referral hospital. We compared two groups based on albumin receipt within the initial six resuscitation hours (albumin group vs. non-albumin group). We performed a 1:2 propensity score matching to assess shock-free time in ICU as the primary outcome.\n\n\nRESULTS\nOf 2,732 patients with medical sepsis, 286 cases in the albumin group were matched with 549 individuals in the non-albumin group. Compared to the non-albumin group, the albumin group required more intravenous fluids and had higher net fluid balance, lower mean arterial pressure, and lower serum base excess level in the initial 6 and 24\u200ahours of resuscitation. Shock-free time, ICU and hospital length of stay, and 28-day mortality were not different between albumin and non-albumin groups (56 vs. 66\u200ahours, P\u200a=\u200a0.18; 3.5 vs. 3.7\u200adays, P\u200a=\u200a0.61; 9.1 vs. 9.5\u200adays, P\u200a=\u200a0.27; 36 vs. 32%, P\u200a=\u200a0.25, respectively).\n\n\nCONCLUSIONS\nUsing albumin during the initial six hours of resuscitation was not associated with benefits in clinical outcomes of patients with medical sepsis.