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

Abstract

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.

Hypoalbuminemia affects one third of acute pancreatitis patients and is independently associated with severity and mortality

“…As we know, albumin is similarly associated with outcomes in sepsis and septic shock; randomized controlled trials in this field could be a start 17 , 21 . The controversial results of studies and meta-analyses in this field may be explained by heterogeneous patient populations and the time sensitivity of this treatment 22 .…”

Hypoalbuminemia, An Independent Risk Factor for Severity and Mortality Affects One Third of Patients in Acute Pancreatitis: Multicenter Prospective International Cohort Analysis

“…As we know, albumin is similarly associated with outcomes in sepsis and septic shock; randomized controlled trials on this eld could be a starting block 15,17 . The controversial results of studies and meta-analyses on this eld may be explained by heterogeneous patient populations and the time sensitivity of this treatment 18 .…”

Evaluation of Evidence, Pharmacology, and Interplay of Fluid Resuscitation and Vasoactive Therapy in Sepsis and Septic Shock

“…The randomized controlled trial ALBIOS showed an improvement in time to suspension of the administration of vasopressor or inotropic agents ( P = 0.007) with administration of 300 mL 20% albumin solution (73). One retrospective, propensity score-matched cohort study of 670 patients in septic shock sought to further evaluate this association (74). While albumin was not associated days alive and free of vasopressors (17.4 vs. 19.4 days, P = 0.160), this study was limited as albumin timing and dose was not protocolized.…”