Brinkman Hannah M, Kashani Kianoush B, Gallo de Moraes Alice, Cole Kristin C, Simonetto Douglas A, Nei Andrea M
Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA.
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Can J Gastroenterol Hepatol. 2025 May 9;2025:8637440. doi: 10.1155/cjgh/8637440. eCollection 2025.
The choice of resuscitation fluid remains debated for patients with septic shock. While patients with cirrhosis may benefit from albumin administration, the efficacy of albumin for resuscitation in cirrhotic patients with septic shock remains unclear. This is a historical cohort study of patients with cirrhosis admitted for septic shock to the intensive care unit (ICU) at a tertiary referral hospital from January 2007 to May 2017. Patients were stratified based on using albumin for fluid resuscitation within six hours of ICU admission. The primary outcome was the percentage of time during the first 48 h of ICU admission that patients were alive and shock-free. Linear regression was used to compare this outcome between groups, and a multivariable analysis was performed to account for baseline differences between study populations. Of the 132 patients with cirrhosis admitted for septic shock, albumin was administered within the first six hours of ICU admission for 84 patients (64%). The albumin and nonalbumin groups had similar percentages of shock-free time during the first 48 h of ICU admission (9.0% vs. 20.2%, = 0.073) and ICU length of stay (5.6 vs. 3.7 days, = 0.093). No differences were observed in clinical outcomes of end-organ dysfunction, such as the need for kidney replacement therapy or mechanical ventilation. Administration of albumin during the first 6 h of ICU admission as an adjunctive resuscitation fluid to crystalloids was not associated with improved shock-free time in the ICU or clinical outcomes in patients with cirrhosis and septic shock.
对于感染性休克患者，复苏液体的选择仍存在争议。虽然肝硬化患者可能从白蛋白输注中获益，但白蛋白用于肝硬化合并感染性休克患者复苏的疗效仍不明确。这是一项对2007年1月至2017年5月在一家三级转诊医院重症监护病房（ICU）因感染性休克入院的肝硬化患者进行的历史性队列研究。根据患者在ICU入院后6小时内是否使用白蛋白进行液体复苏进行分层。主要结局是ICU入院后48小时内患者存活且无休克的时间百分比。采用线性回归比较两组间的这一结局，并进行多变量分析以考虑研究人群之间的基线差异。在132例因感染性休克入院的肝硬化患者中，84例（64%）在ICU入院后的前6小时内接受了白蛋白输注。白蛋白组和非白蛋白组在ICU入院后48小时内无休克时间的百分比相似（9.0%对20.2%，P = 0.073），ICU住院时间也相似（5.6天对3.7天，P = 0.093）。在终末器官功能障碍的临床结局方面，如肾脏替代治疗或机械通气的需求，未观察到差异。在ICU入院后6小时内给予白蛋白作为晶体液的辅助复苏液体，与肝硬化合并感染性休克患者在ICU的无休克时间改善或临床结局无关。
