Patanwala Asad E, Flannery Alexander H, Mehta Hemalkumar B, Hills Thomas E, McArthur Colin J, Erstad Brian L
Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia; Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY; Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, KY.
Chest. 2025 Apr;167(4):1090-1098. doi: 10.1016/j.chest.2024.10.012. Epub 2024 Oct 18.
Albumin infusions may be renally protective or harmful in patients with septic shock who have kidney impairment. This can affect the need for renal replacement therapy (RRT) and in-hospital mortality.
Does the early use of albumin mitigate the need for RRT or in-hospital mortality in patients with septic shock and kidney impairment on hospital admission?
This was a retrospective multicenter inverse probability-of-treatment weighted cohort study conducted in 220 geographically diverse community and teaching hospitals across the United States. Adult patients were included if they had septic shock and kidney impairment on hospital admission. Patients were categorized as those who received albumin (within 24 hours of admission) or no albumin during hospitalization. Proportion of patients with RRT or in-hospital mortality were compared between groups.
Of the 9,988 patients included in the final cohort, 7,929 did not receive albumin and 2,059 received albumin. Patients had a mean ± SD age of 67.8 ± 14.8 years, 46.3% were female, and the mean estimated glomerular filtration rate was 32 ± 12 mL/min/1.73 m on the day of admission. In the weighted cohort, the composite outcome of RRT or in-hospital mortality occurred in 33.8% without albumin and 39.7% with albumin treatment (OR, 1.29; 95% CI, 1.14-1.47; P < .001). There was no significant difference with 5% albumin (OR, 1.07; 95% CI, 0.84-1.37), but there was a significantly increased risk with 25% albumin (OR, 1.43; 95% CI, 1.16-1.76).
In patients with septic shock and kidney impairment on hospital admission, early albumin use may be associated with an increased composite outcome of RRT or in-hospital mortality. This increased risk is most associated with hyperoncotic albumin rather than iso-oncotic albumin.
对于合并肾功能损害的感染性休克患者，输注白蛋白可能具有肾脏保护作用，也可能有害。这可能会影响肾脏替代治疗（RRT）的需求和住院死亡率。
对于入院时合并感染性休克和肾功能损害的患者，早期使用白蛋白是否可减少RRT需求或降低住院死亡率？
这是一项回顾性多中心治疗逆概率加权队列研究，在美国220家地理位置各异的社区医院和教学医院开展。纳入入院时患有感染性休克和肾功能损害的成年患者。患者被分为住院期间接受白蛋白治疗（入院后24小时内）或未接受白蛋白治疗的两组。比较两组接受RRT或住院死亡患者的比例。
最终队列纳入的9988例患者中，7929例未接受白蛋白治疗，2059例接受了白蛋白治疗。患者的平均年龄±标准差为67.8±14.8岁，46.3%为女性，入院当天平均估算肾小球滤过率为32±12 mL/min/1.73m²。在加权队列中，未接受白蛋白治疗的患者RRT或住院死亡的复合结局发生率为33.8%，接受白蛋白治疗的患者为39.7%（比值比，1.29；95%置信区间，1.14 - 1.47；P <.001）。使用5%白蛋白时无显著差异（比值比，1.07；95%置信区间，0.84 - 1.37），但使用25%白蛋白时风险显著增加（比值比，1.43；95%置信区间，1.16 - 1.76）。
对于入院时合并感染性休克和肾功能损害的患者，早期使用白蛋白可能与RRT或住院死亡的复合结局增加有关。这种风险增加主要与高渗白蛋白而非等渗白蛋白有关。
