Wiedermann Christian J, Zaboli Arian, Lucente Fabrizio, Filippi Lucia, Maggi Michael, Ferretto Paolo, Cipriano Alessandro, Voza Antonio, Ghiadoni Lorenzo, Turcato Gianni
Institute of General Medicine and Public Health, Claudiana College of Health Professions, 39100 Bolzano, Italy.
Health Professions Management, South Tyrolean Health Authority (SABES-ASDAA), 39100 Bolzano, Italy.
J Clin Med. 2025 Jul 24;14(15):5255. doi: 10.3390/jcm14155255.
: Intravascular albumin mass represents the total quantity of albumin circulating within the bloodstream and may serve as a physiologically relevant marker of vascular integrity and fluid distribution in sepsis. While low serum albumin levels are acknowledged as prognostic indicators, dynamic assessments based on albumin mass remain insufficiently explored in patients outside the intensive care unit. : To describe the temporal changes in intravascular albumin mass in patients with community-acquired sepsis and to examine its relationship with fluid balance and thirty-day mortality. : This prospective observational study encompassed 247 adults diagnosed with community-acquired sepsis who were admitted to a high-dependency hospital ward specializing in acute medical care. The intravascular albumin mass was calculated daily for a duration of up to five days, utilizing plasma albumin concentration and estimated plasma volume derived from anthropometric and hematologic data. Net albumin leakage was defined as the variation in intravascular albumin mass between consecutive days. Fluid administration and urine output were documented to ascertain cumulative fluid balance. Repeated-measures statistical models were employed to evaluate the associations between intravascular albumin mass, fluid balance, and mortality, with adjustments made for age, comorbidity, and clinical severity scores. : The intravascular albumin mass exhibited a significant decrease during the initial five days of hospitalization and demonstrated an inverse correlation with the cumulative fluid balance. A greater net leakage of albumin was associated with a positive fluid balance and elevated mortality rates. Furthermore, a reduced intravascular albumin mass independently predicted an increased risk of mortality at thirty days. : A reduction in intravascular albumin mass may suggest ineffective fluid retention and the onset of capillary leak syndrome. This parameter holds promise as a clinically valuable, non-invasive indicator for guiding fluid resuscitation in cases of sepsis.
血管内白蛋白量代表循环于血液中的白蛋白总量，可作为脓毒症中血管完整性和液体分布的生理相关标志物。虽然低血清白蛋白水平被认为是预后指标，但在重症监护病房以外的患者中，基于白蛋白量的动态评估仍未得到充分探索。
描述社区获得性脓毒症患者血管内白蛋白量的时间变化，并研究其与液体平衡和30天死亡率的关系。
这项前瞻性观察性研究纳入了247名被诊断为社区获得性脓毒症的成年人，他们被收治于一家专门从事急性医疗护理的高依赖医院病房。利用血浆白蛋白浓度以及根据人体测量和血液学数据估算的血浆量，连续5天每日计算血管内白蛋白量。净白蛋白渗漏定义为连续两天血管内白蛋白量的变化。记录液体输入量和尿量以确定累积液体平衡。采用重复测量统计模型评估血管内白蛋白量、液体平衡和死亡率之间的关联，并对年龄、合并症和临床严重程度评分进行调整。
血管内白蛋白量在住院的最初5天显著下降，且与累积液体平衡呈负相关。白蛋白净渗漏增加与液体正平衡和死亡率升高相关。此外，血管内白蛋白量降低独立预测30天死亡率增加。
血管内白蛋白量减少可能提示液体潴留无效和毛细血管渗漏综合征的发生。该参数有望成为指导脓毒症患者液体复苏的具有临床价值的非侵入性指标。
