Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Italy.
Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
J Crit Care. 2021 Jun;63:83-91. doi: 10.1016/j.jcrc.2021.01.016. Epub 2021 Feb 9.
The best fluid replacement strategy and the role of albumin in immunocompromised patients with sepsis is unclear.
We performed a secondary analysis of immunocompromised patients enrolled in the ALBIOS trial which randomized patients with severe sepsis or septic shock to receive either 20% albumin (target 30 g per liter or more) and crystalloid or crystalloid alone during ICU stay.
Of 1818 patients originally enrolled, 304 (16.4%) were immunocompromised. One-hundred-thirty-nine (45.7%) patients were randomized in the albumin while 165 (54.2%) in the crystalloid group. At 90 days, 69 (49.6%) in the albumin group and 89 (53.9%) in the crystalloids group died (hazard ratio - HR - 0.94; 95% CI 0.69-1.29). No differences were observed with regards to 28-day mortality, SOFA score (and sub-scores), length of stay in the ICU and in the hospital, proportion of patients who had developed acute kidney injury or received renal replacement therapy, duration of mechanical ventilation. Albumin was not independently associated with a higher or lower 90-day mortality (HR 0.979, 95% CI 0.709-1.352) as compared to crystalloid.
Albumin replacement during the ICU stay, as compared with crystalloids alone, did not affect clinical outcomes in a cohort of immunocompromised patients with sepsis.
免疫功能低下的脓毒症患者最佳的液体复苏策略和白蛋白的作用仍不明确。
我们对免疫功能低下的脓毒症患者进行了二次分析，这些患者来自 ALBIOS 试验，该试验将严重脓毒症或脓毒性休克患者随机分为 ICU 期间接受 20%白蛋白（目标 30 g/L 或更高）和晶体液或仅接受晶体液治疗的两组。
在最初纳入的 1818 例患者中，有 304 例（16.4%）免疫功能低下。139 例（45.7%）患者被随机分配至白蛋白组，165 例（54.2%）患者被随机分配至晶体液组。90 天时，白蛋白组 69 例（49.6%）和晶体液组 89 例（53.9%）死亡（风险比 - HR - 0.94；95%CI 0.69-1.29）。两组 28 天死亡率、SOFA 评分（及其子评分）、ICU 和住院时间、发生急性肾损伤或接受肾脏替代治疗的患者比例、机械通气时间均无差异。与晶体液相比，白蛋白并未使 ICU 期间的患者 90 天死亡率更高或更低（HR 0.979，95%CI 0.709-1.352）。
与单独使用晶体液相比，免疫功能低下的脓毒症患者 ICU 期间接受白蛋白治疗并未改善临床结局。
