Abstract
BackgroundFluid therapy is a cornerstone in the treatment of sepsis. Recently, the guidelines have recommended the combined administration that using crystalloids plus albumin for septic patients, but the optimal timing for albumin combined is still unclear. The objective of this study was to investigate the association of timing of albumin combined with 28-day mortality in patients with sepsis.MethodsWe involved septic patients from the Medical Information Mart for Intensive Care (MIMIC)-IV database, and these patients were categorized into crystalloids group (crystalloids alone) and early combination group (crystalloids combined albumin at 0–24 h). The primary outcome was 28-day mortality. We used propensity score matching (PSM) to adjust confounding and restricted mean survival time (RMST) analysis was conducted to quantify the beneficial effect on survival due to the combination group.ResultsWe categorized 6597 and 920 patients in the “crystalloids alone” and “early combination”, respectively. After PSM, compared to the crystalloids group, the combination group was associated with the increased survival among 28-day (increased survival: 3.39 days, 95% CI 2.53–4.25; P < 0.001) after ICU admission. Patients who received albumin combination at the first 24-h was associated with prolonged LOS in ICU (10.72 days vs. 8.24 days; P < 0.001) but lower risk of 28-day mortality (12.5% vs 16.4%, P = 0.003) than those received crystalloids alone.ConclusionIn septic patients, receiving albumin combined within the first 24-h after crystalloids administration was associated with an increment of survival in 28 days.
Highlights
Fluid therapy is a cornerstone in the treatment of sepsis
The Medical Information Mart for Intensive Care (MIMIC)-IV database included 11,263 adult patients with sepsis, and 7519 patients were included in this study (Fig. 1)
Compared to the crystalloids group, patients with 3 stages of acute kidney injury (AKI), higher Simplified Acute Physiology Score II (SAPS) Simplified Acute Physiology Score II (II) score, Sequential Organ Failure Assessment (SOFA) score, and serum lactate levels were more likely to combine the albumin with crystalloids as the fluid administration within the first 24 h
Summary
Fluid therapy is a cornerstone in the treatment of sepsis. Recently, the guidelines have recommended the combined administration that using crystalloids plus albumin for septic patients, but the optimal timing for albumin combined is still unclear. A few subgroup analyses showed that the colloids group may potentially reduce mortality [14, 16] Crystalloids, as they are safe, inexpensive, and widely available, remain the first line of fluid administration in patients with sepsis [17]. The combined administration that using crystalloids plus albumin for initial resuscitation and subsequent intravascular volume replacement has been widely used for septic patients in fluid therapy and was recommended by Surviving Sepsis Campaign Guidelines [19]. It remains unclear when albumin should be combined after the initiation of fluid therapy
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