Turcato Gianni, Filippi Lucia, Zaboli Arian, Ferretto Paolo, Milazzo Daniela, Maggi Michael, Stefani Francesca, Parodi Marta, Marchetti Massimo, Wiedermann Christian J
Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy; UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy.
Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy.
Am J Med Sci. 2025 Apr;369(4):451-459. doi: 10.1016/j.amjms.2024.12.002. Epub 2024 Dec 3.
Serum albumin plays a pivotal role in the exchange between interstitial and vascular compartments, and reduced levels of this biomarker appear to be associated with negative prognosis in septic patients. The correlation between the volume effect in sepsis therapy and the kinetics of serum albumin is unclear.
To investigate the relationship between serum albumin and fluid bolus in relation to its prognostic role in septic patients.
A single-center prospective observational study conducted from September 2022 to February 2024. All patients with sepsis admitted from the Emergency Department to the Intermediate Medical Care Unit (IMCU) were considered. Post-fluid bolus serum albumin was obtained after fluid bolus. The albumin value was correlated with the volume effect of the fluid bolus, and multivariate models were performed to evaluate its potential independent effect on 30-day mortality.
179 patients were enrolled. Pre-fluid bolus serum albumin was 2.55 g/dL (SD 0.51) with a multivariate OR for 30-day mortality of 1.170 (95 % CI 1.055-1.297, p = 0.003). After the fluid bolus, which resulted in a fluid balance percentage of +23.1 % (SD 7.1) and a mean Fractional Plasma Dilution of -0.48 (SD 0.18), albumin showed a mean decrease of -0.28 g/dL (SD 0.28) with a multivariate OR for 30-day mortality of 1.198 (95 % CI 1.065-1.348, p = 0.003). Post-fluid bolus albumin was negatively correlated with cumulative fluid balance and hemodilution.
The volume effect of fluid bolus is correlated with a decrease in serum albumin, and low albumin levels are associated with a high risk of mortality.
血清白蛋白在组织间隙和血管腔隙之间的物质交换中起关键作用，该生物标志物水平降低似乎与脓毒症患者的不良预后相关。脓毒症治疗中的容量效应与血清白蛋白动力学之间的相关性尚不清楚。
探讨血清白蛋白与液体冲击量之间的关系及其在脓毒症患者中的预后作用。
2022年9月至2024年2月进行的一项单中心前瞻性观察研究。纳入所有从急诊科收治到中级医疗护理单元（IMCU）的脓毒症患者。液体冲击后获取冲击后血清白蛋白。将白蛋白值与液体冲击的容量效应相关联，并进行多变量模型以评估其对30天死亡率的潜在独立影响。
共纳入179例患者。液体冲击前血清白蛋白为2.55 g/dL（标准差0.51），30天死亡率的多变量比值比为1.170（95%置信区间1.055-1.297，p = 0.003）。液体冲击后，液体平衡百分比为+23.1%（标准差7.1），平均血浆稀释分数为-0.48（标准差0.18），白蛋白平均下降-0.28 g/dL（标准差0.28），30天死亡率的多变量比值比为1.198（95%置信区间1.065-1.348，p = 0.003）。冲击后白蛋白与累积液体平衡和血液稀释呈负相关。
液体冲击的容量效应与血清白蛋白降低相关，低白蛋白水平与高死亡风险相关。
