Albumin Replacement in Patients with Severe Sepsis or Septic Shock

Circulating presepsin (soluble CD14 subtype) as a marker of host response in patients with severe sepsis or septic shock: data from the multicenter, randomized ALBIOS trial

“…In the ALBIOS trial, patients were randomized to either albumin and crystalloids or crystalloids alone for volume replacement [17]. Albumin replacement did not improve survival at 28 and 90 days in the overall population, but gave small, significant hemodynamic advantages and was more effective in patients with septic shock.…”

“…The patients were randomly assigned to receive either 20 % albumin and crystalloids or crystalloids alone, from randomization until day 28 or discharge from the ICU, whichever came first. Study design, inclusion and exclusion criteria, and main results were published elsewhere [17] and are summarized in the Supplementary Appendix.…”

“…Here, we extend our investigations on the clinical role of presepsin assay for monitoring host response and appropriateness of antibiotic therapy to a larger subpopulation of 997 patients enrolled in a multicenter randomized clinical trial that assessed the efficacy of albumin replacement in severe sepsis and septic shock [17]. In particular, we aimed to elucidate (1) the characteristics associated with increased presepsin levels, (2) the clinical value of presepsin monitoring during the disease, both in relation to the development of complications and to the treatment applied, and (3) prognostic accuracy of presepsin for early and long-term outcomes.…”

State of the art in fluid and volume therapy

“…The ALBIOS trial evaluated a patient collective with severe sepsis or septic shock. The experimental group received albumin replacement (not for volume therapy, but rather to increase the serum albumin concentration to ≥3 g/dl) and the control group received only crystalloid solution [45]. There was no difference in terms of mortality between the two groups [45].…”

“…The experimental group received albumin replacement (not for volume therapy, but rather to increase the serum albumin concentration to ≥3 g/dl) and the control group received only crystalloid solution [45]. There was no difference in terms of mortality between the two groups [45]. In the similarly conceived EARSS trial, a reduction in absolute and relative mortality of 2.2% and 8.4%, respectively, was observed in the human albumin group compared to the crystalloid group after 28 days (p > 0.05) [46].…”