Albumin replacement in patients with severe sepsis or septic shock.

The ALBIOS study, a multicentre open-label randomised controlled trial performed in 100 Italian ICUs, evaluated the effect of albumin supplementation on 28-day mortality in patients with severe sepsis or septic shock. In the control group, patients received only crystalloids as clinically indicated, while in the study group patients received crystalloids and 20% albumin to maintain serum albumin concentration at 30 g/L or above. During the first 7 days, the total daily amount of administered fluids was not different between the two groups while the daily amount of administered crystalloids and the net fluid balance were significantly lower in the study group. In the overall population, 28-day and 90-day mortality did not differ between the two groups. In a post-hoc subgroup analysis that included patients with septic shock (1121 of the 1781 analysed patients) at time of enrollment, 90-day mortality was significantly lower (relative risk: 0.87; 95% CI: 0.77-0.99; p=0.03) in the study group.

These results indicate, firstly, that albumin in this high-risk population is safe, and, secondly, that albumin supplementation might be beneficial in patients with septic shock. However, this latter result need to be confirmed by an adequately powered trial.

– Philippe Van der Linden

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