Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, No. 87, Dingjiaqiao Road, Gulou District, Nanjing, 210009, People's Republic of China.
Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215000, People's Republic of China.
Crit Care. 2023 Jul 28;27(1):300. doi: 10.1186/s13054-023-04587-3.
Albumin infusion is the primary therapeutic strategy for septic patients with liver cirrhosis. Although recent studies have investigated the efficacy of albumin in the resuscitation stage of septic patients with liver cirrhosis, it remains unclear whether daily albumin administration can improve outcomes. Furthermore, the indications for initiating albumin therapy are not well defined.
Septic patients with liver cirrhosis were obtained from the Medical Information Mart for Intensive Care (MIMIC-IV 2.0) database. Marginal structural Cox models were employed to investigate the association between daily albumin infusion and 28-day mortality. We also aimed to explore under what circumstances enrolled patients could benefit most from albumin administration, based on the clinical parameters collected on the day of albumin infusion, including serum albumin concentration, serum lactate concentration, mean arterial pressure (MAP), and vasopressor dosage.
A total of 2265 patients were included in the final analysis, of whom 1093 (48.3%) had received albumin treatment at least once. The overall 28-day mortality was 29.6%. After marginal structural modeling, daily albumin infusion was associated with a reduced risk of 28-day death (hazard ratio, 0.76; 95% CI 0.61-0.94). We found that patients benefit most from albumin infusion when initiated on the day of serum albumin concentration between 2.5 and 3.0 g/dL, serum lactate concentration greater than or equal to 2 mmol/L, MAP less than 60 mmHg, or vasopressor dosage between 0.2 and 0.3 mcg/kg/min (norepinephrine equivalent, NEE).
Albumin infusion is associated with a reduction in mortality in septic patients with liver cirrhosis under specific circumstances. Serum albumin concentration, serum lactate, MAP, and vasopressor dosage were found to be modifiers of treatment effectiveness and should be considered when deciding to initial albumin infusion.
白蛋白输注是肝硬化合并脓毒症患者的主要治疗策略。虽然最近的研究已经探讨了白蛋白在肝硬化合并脓毒症患者复苏阶段的疗效，但白蛋白的每日给药是否能改善预后仍不清楚。此外，白蛋白治疗的适应证尚未明确。
从医疗信息集市重症监护数据库（MIMIC-IV 2.0）中获取肝硬化合并脓毒症患者。采用边缘结构 Cox 模型探讨每日白蛋白输注与 28 天死亡率之间的关系。我们还旨在根据白蛋白输注日收集的临床参数（包括血清白蛋白浓度、血清乳酸浓度、平均动脉压（MAP）和血管加压药剂量），探讨在何种情况下患者可以从白蛋白给药中获益最大。
共纳入 2265 例患者进行最终分析，其中 1093 例（48.3%）至少接受过一次白蛋白治疗。总的 28 天死亡率为 29.6%。经边缘结构建模后，每日白蛋白输注与降低 28 天死亡风险相关（风险比，0.76；95%置信区间，0.61-0.94）。我们发现，当血清白蛋白浓度在 2.5 至 3.0 g/dL 之间、血清乳酸浓度大于或等于 2 mmol/L、MAP 小于 60 mmHg 或血管加压药剂量在 0.2 至 0.3 mcg/kg/min（去甲肾上腺素当量，NEE）时开始输注白蛋白，患者获益最大。
在特定情况下，白蛋白输注与肝硬化合并脓毒症患者死亡率降低相关。血清白蛋白浓度、血清乳酸、MAP 和血管加压药剂量是治疗效果的修饰因子，在决定开始白蛋白输注时应考虑这些因素。
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