Wuxi School of Medicine, Jiangnan University, Wuxi, China.
Department of Emergency and Critical Care, Changzheng Hospital, Naval Medical University, Shanghai, China.
J Intensive Care Med. 2023 Aug;38(8):679-689. doi: 10.1177/08850666231170778. Epub 2023 Apr 20.
The best type of resuscitation fluids for sepsis and septic shock patients remains unclear. The aim of this study was to evaluate the efficacy of different concentrations of albumin on reducing the mortality rate of theses patients by meta-analysis.
PubMed, EMBASE, and Web of Science databases were used for screening the relevant studies. Randomized controlled trials (RCTs) were eligible if they compared the effects of albumin with crystalloid on mortality in patients with sepsis and septic shock. Data were examined and extracted by two reviewers independently. Any disagreements were resolved by consensus with or without the help from a third reviewer. Data including mortality, sample size of the patients, and resuscitation endpoints were extracted. Meta-analysis was carried based on the corresponding odds ratios with 95% confidence intervals.
Eight studies with a total of 5124 septic patients and 3482 septic shock patients were included in this study. Compared with crystalloid, the use of albumin may represent a trend toward reduced the 90-day mortality of septic patients (OR 0.91 [0.80, 1.02]; = .11) and significantly improved the outcome of septic shock patients (OR 0.85 [0.74, 0.99]; = .04). Further analysis showed a potentially beneficial role of both 4% to 5% and 20% albumin on reducing the mortality of septic patients. The use of 20% albumin significantly decreased the 90-day mortality of septic shock patients (OR 0.81 [0.67, 0.98]; = .03), which was better than 4% to 5% albumin and crystalloid.
Albumin treatment, particularly 20% albumin, significantly reduced the 90-day mortality in septic shock patients. Both 4% to 5% and 20% of albumin may work better than crystalloid in improving the survival rate of patients with sepsis, but more relative RCTs are required for validation.
脓毒症和脓毒性休克患者最佳的复苏液类型仍不清楚。本研究旨在通过荟萃分析评估不同浓度白蛋白对降低此类患者死亡率的疗效。
使用 PubMed、EMBASE 和 Web of Science 数据库筛选相关研究。如果白蛋白与晶体液比较对脓毒症和脓毒性休克患者死亡率的影响的随机对照试验（RCT）符合纳入标准。由两位审阅者独立检查和提取数据。任何分歧均通过共识解决，必要时可寻求第三位审阅者的帮助。提取数据包括死亡率、患者样本量和复苏终点。基于相应的比值比及其 95%置信区间进行荟萃分析。
本研究共纳入 8 项研究，总计 5124 例脓毒症患者和 3482 例脓毒性休克患者。与晶体液相比，白蛋白的使用可能代表降低脓毒症患者 90 天死亡率的趋势（OR 0.91 [0.80, 1.02]；= 0.11），并显著改善脓毒性休克患者的结局（OR 0.85 [0.74, 0.99]；= 0.04）。进一步分析表明，4%至 5%和 20%白蛋白均可能降低脓毒症患者的死亡率。使用 20%白蛋白可显著降低脓毒性休克患者 90 天死亡率（OR 0.81 [0.67, 0.98]；= 0.03），优于 4%至 5%白蛋白和晶体液。
白蛋白治疗，特别是 20%白蛋白，可显著降低脓毒性休克患者 90 天死亡率。4%至 5%和 20%白蛋白在提高脓毒症患者生存率方面可能优于晶体液，但需要更多的相关 RCT 加以验证。
