A word of caution regarding proposed benefits of albumin from ALBIOS: a dose of healthy skepticism

Flannery, Alexander H.; Kane, Sean P.; Coz-Yataco, Angel O

doi:10.1186/s13054-014-0509-x

Cited by 5 publications

(5 citation statements)

References 4 publications

(4 reference statements)

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“…In the spirit of accepting our opponent's challenge to debate the theory rather than the details of trial results, 1 we keep our statistical concerns brief, as they have been outlined elsewhere. 2 We agree that shock defines a well-characterized patient subset; however, subgroup analysis, even in a well-defined subpopulation, has the potential for selection bias and sampling error. It is plausible that data exploration in ALBIOS to identify a subgroup with a positive treatment effect resulted in an overestimation of albumin's potential effect.…”

Section: Caironi P Tognoni G Massonmentioning

confidence: 71%

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Rebuttal From Drs Coz Yataco, Flannery, and Simpson

Yataco

Flannery

Simpson

2016

Chest

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Section: Caironi P Tognoni G Massonmentioning

confidence: 71%

“…The only clinically relevant harm (ie, on the renal system) reported retrospectively in patients with shock receiving hyperoncotic albumin-containing solutions 7 was never confirmed, as no effect on renal function was observed in our trial. 2 Third, is administration of albumin a cost-effective treatment? Few studies have analyzed this issue.…”

mentioning

confidence: 99%

Rebuttal From Drs Coz Yataco, Flannery, and Simpson

Yataco

Flannery

Simpson

2016

Chest

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“…2 Significant issues raised with the validity of this evaluation are detailed elsewhere. 20 However, the tertiary analysis from ALBIOS did indicate that septic shock patients who were administered 20% albumin required significantly fewer days of vasopressor or inotrope therapy than those who did not receive any albumin (3 vs 4 days, respectively; P = 0.007). 2 Differences in product used (20% vs 4%) and volumes administered also confound the direct comparison of these 2 trials.…”

Section: Discussionmentioning

confidence: 96%

Impact of Hyperoncotic Albumin on Duration of Vasopressor Support in Septic Shock: A Propensity Score–Matched Analysis

et al. 2020

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Background While albumin has not been shown to reduce mortality in sepsis and septic shock, a tertiary analysis of a large trial suggested that it may reduce the duration of vasopressor use in septic shock. Objective We sought to test if 25% albumin administration was associated with reduced cumulative vasopressor use in septic shock in a real-world setting. Methods This was a retrospective, propensity score–matched cohort study of septic shock in which patients receiving albumin were compared with a matched cohort of those not receiving albumin. The primary outcome was days alive and free of vasopressors. Results The matched cohort included 335 patients who received albumin and 335 who did not. The days alive and free of vasopressors were similar between the albumin and no albumin groups: 17.4 (0-24.8) versus 19.4 (0-25.3); P = 0.160. Similarly, in-hospital mortality was no different between groups (46.9% vs 44.8%; P = 0.587). Receipt of albumin was associated with fewer ventilator-free and intensive care unit (ICU)-free days: 0 (0-19) versus 11 (0-23), P = 0.007, and 0 (0-18) versus 10.6 (0-22.1), P = 0.002, respectively. Conclusion and Relevance Albumin use in septic shock was not associated with additional days alive and free of vasopressors or in-hospital mortality. The finding of fewer ventilator- and ICU-free days may reflect selection of patients who were critically ill for longer periods of time before or after albumin administration. Additional study is needed to clarify the impact that timing may have on the effectiveness of albumin in septic shock.

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“…T he administration of albumin in critically ill patients has been a controversial topic for many decades (1)(2)(3)(4)(5). Although this abundant protein and key player in microvascular fluid exchange may have gained popularity in recent years, a lot of reservations concerning its use remain (6)(7)(8)(9)(10)(11).…”

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confidence: 99%

The Effect of Albumin Administration in Critically Ill Patients: A Retrospective Single-Center Analysis

Abdelhamid,

Achermann,

Hollinger

et al. 2024

Critical Care Medicine

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OBJECTIVES: The aim of this study was to analyze the development of albumin administration in patients admitted to the adult ICU. In addition, we assessed the impact of albumin administration on serum hemoglobin concentration. DESIGN: We conducted a retrospective single-center study including all patients who were admitted to the ICU from January 2013 to December 2021 and stayed at least 24 hours. SETTING: The study was conducted in an academic hospital (University Hospital Basel, Switzerland). PATIENTS: A total of 20,927 admissions were included, of which 3748 received albumin at least once during their ICU stay. To analyze volume expansion, 2006 admissions met the inclusion criteria, namely at least two hemoglobin measurements within 12 hours, one albumin delivery, and experienced no bleeding, dialysis, or transfusions during this period. INTERVENTIONS: None. MEASUREMENTS: We examined the hemoglobin levels before and after albumin administration and compared them with a matched control group to assess the amount and duration of volume expansion. MAIN RESULTS: From 2013 to 2021 the proportion of critically ill patients treated with albumin rose from 5.0% to 32.5%. An overproportioned increase in albumin use could be seen in surgical patients (4.7–47.2%) and in those receiving RBC transfusion (13.7–72.6%). In those patients receiving albumin, a significant drop in hemoglobin of around 5 g/L on average could be observed following treatment with albumin. CONCLUSION: Hemodilution was observable for at least 12 hours after albumin administration and may have caused a decrease in hemoglobin concentration of greater than 8 g/L when isooncotic albumin solution (5%, 25 g in 500 mL) was administered. This makes albumin, especially in its isooncotic form, an ideal colloid to achieve long-lasting volume expansion. However, RBC transfusions may increase under albumin therapy, as transfusion thresholds may be undershot after albumin administration.

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A word of caution regarding proposed benefits of albumin from ALBIOS: a dose of healthy skepticism

Cited by 5 publications

References 4 publications

Rebuttal From Drs Coz Yataco, Flannery, and Simpson

Rebuttal From Drs Coz Yataco, Flannery, and Simpson

Impact of Hyperoncotic Albumin on Duration of Vasopressor Support in Septic Shock: A Propensity Score–Matched Analysis

The Effect of Albumin Administration in Critically Ill Patients: A Retrospective Single-Center Analysis

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