Expert consensus on the use of human serum albumin in critically ill patients

Yu, Yuetian; Liu, Jiao; Hu, Bo; Wang, Ruilan; Yang, Xianghong; Shang, Xiuling; Wang, Gang; Wang, Changsong; Li, Bailing; Gong, Yi; Zhang, Sheng; Li, Xin; Wang, Lu; Shao, Min; Meng, Mei; Zhu, Feng; Shang, You; Xu, Qianghong; Wu, Zijian; Chen, Dechang

doi:10.1097/cm9.0000000000001661

Cited by 36 publications

(22 citation statements)

References 139 publications

(261 reference statements)

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“…Pathogenic bacteria were isolated using cultures in the microbiological laboratory, and pathogenic viruses were identified using polymerase chain reaction (PCR). Recipients with hypoalbuminemia (defined as the serum albumin level was <35 g/L) received an albumin infusion before the operation ( 14 ), and those with renal anemia or hemoglobin levels lower than 70 g/L received a blood infusion ( 15 , 16 ).…”

Section: Methodsmentioning

confidence: 99%

A simple nomogram for predicting infectious diseases in adult kidney transplantation recipients

Chen

Zhang

Zhuang

et al. 2022

Front. Public Health

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ObjectiveTo investigate the risk factors of infectious diseases in adult kidney transplantation recipients and to establish a simple and novel nomogram to guide the prophylactic antimicrobial therapy.MethodsPatients who received kidney transplantation between January 2018 and October 2021 were included in the study and were divided into a training and a testing set at a 1:1 ratio. Risk factors correlated to infectious diseases were selected using a Least Absolute Shrinkage and Selection Operator (LASSO) regression model. The prediction model was built by incorporating the variables selected by the LASSO model into a logistic regression equation. Calibration curves and receiver operating characteristic (ROC) curves were also applied to assess the model calibration and discrimination. A nomogram consisting of the selected factors was established to provide individualized risks of developing infections. Decision curve analysis (DCA) was adopted to estimate the net benefit and reduction in interventions for a range of clinically reasonable risk thresholds.ResultsIn all, 863 adult kidney recipients were included in the study, and 407 (47.16%) of them developed infectious diseases during the 3-year follow–up period. A total of 8 variables were selected using LASSO regression and were retained for subsequent model construction and infection prediction. The area under the curve (AUC) was 0.83 and 0.81 in the training and testing sets, with high F scores of 0.76 and 0.77, sensitivity of 0.76 and 0.81, and specificity of 0.88 and 0.74, respectively. A novel nomogram was developed based on 8 selected predictors (requirement for albumin infusion, requirement for red blood cell infusion, triglyceride, uric acid, creatinine, globulin, neutrophil percentage, and white blood cells). The net benefit indicated that the nomogram would reduce unnecessary interventions at a wide range of threshold probabilities in both sets.ConclusionsAdult kidney transplantation recipients are high-risk hosts for infectious diseases. The novel nomogram consisting of 8 factors reveals good predictive performance and may promote the reasonable antimicrobial prescription. More external validations are required to confirm its effectiveness for further clinical application.

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Section: Methodsmentioning

confidence: 99%

A simple nomogram for predicting infectious diseases in adult kidney transplantation recipients

Chen

Zhang

Zhuang

et al. 2022

Front. Public Health

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“…Albumin physiologically binds to the glycocalyx and prevents its shedding, thereby ensuring vascular integrity and normal capillary permeability. [ 6 , 9 ]…”

Section: Comeback Colloid: Role Of Albumin In the Critically Illmentioning

confidence: 99%

“…Synthesised in the liver, it has a 21-day half-life and is slowly catabolised in the muscles, kidney, and liver. [ 9 ] The Surviving Sepsis Campaign Guidelines 2021 now recommend “using albumin in patients who received large volumes of crystalloids” in view of the recent evidence showing “higher blood pressure at early and later time points,” “higher static filling pressures,” and “lower net fluid balance” with albumin. Although most patients with sepsis and septic shock need high volume infusions, the critical threshold for initiating albumin therapy is yet to be established.…”

Section: Comeback Colloid: Role Of Albumin In the Critically Illmentioning

confidence: 99%

Recent advances in critical care: Part II

Gopal

Sivapurapu

Nag

et al. 2023

Indian Journal of Anaesthesia

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With the increasing number of critically ill patients being admitted to intensive care units (ICUs), newer techniques and treatment modalities continue to evolve for their adequate management. Thus, it has become imperative to understand existing tools and resources, and utilise or repurpose them to achieve better results that can decrease morbidity and mortality. In this writeup, we chose five areas of interest, including analgosedation, role of colloids, recent advancements in the management of respiratory failure, the role of extracorporeal membrane oxygenation, and newer antimicrobials. The role of analgosedation in the critically ill has gained importance with focus on post-ICU syndromes, and albumin has re-entered the fray as a possible repairer of the injured glycocalyx. The coronavirus disease 2019 (COVID-19) pandemic forced us to relook at various ventilator strategies and mechanical support for the failing circulation has now become more common with clear end-points. Rising microbial antibiotic resistance has opened up the research on newer antibiotics.

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“…The timing of early administration of exogenous albumin was de ned as being less than 12 hours after surgery. In our department, 20% albumin is generally administrated either in patients who require persist uid resuscitation, or in patients who need to maintain a high colloidal osmotic pressure, such as patients with intracranial hypertension or a very low albumin level [13].…”

Section: De Nition and Outcomesmentioning

confidence: 99%

The Effects of Administration of Exogenous Albumin Early after Non-cardiac Surgery on Postoperative AKI in Patients with Preoperative Hypoalbuminemia: A Prospective Propensity-score Matching Analysis

Yan

Zhou

Xie

et al. 2022

Preprint

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Background: Evidence has shown that preoperative hypoalbuminemia is independently associated with acute kidney injury (AKI) after non-cardiac surgery. However, little study has investigated the effects of administration of exogenous albumin early after non-cardiac surgery on postoperative AKI in patients with preoperative hypoalbuminemia.Methods: This study was a secondary analysis of the database of a previously conducted prospective cohort study. Data of 661 adult patients who underwent non-cardiac surgery and were admitted to Surgical Intensive Care Unit (SICU) after surgery from May 1, 2019, to November 30, 2020, were collected. 267 patients with preoperative hypoalbuminemia were screened, and divided into two groups according to whether they were administrated with exogenous albumin on the day of SICU admission. The demographic and perioperative data of the two groups were propensity-matched.Results：After propensity score matching, 64 pairs of patients were included in the final analysis. The patients of the albumin group showed a higher serum albumin level on postoperative day 1 than that in patients of the control group [31.3±3.4 vs. 29.7±3.8, P=0.008], however, no difference was observed in postoperative AKI incidence between the two groups (59.4% vs. 62.5%, P=0.717). Furthermore, there was no difference in other prognostic factors, such as the use and duration of mechanical ventilation, number of other postoperative complications, in-hospital mortality, length of SICU stay and postoperative hospital stay.Conclusions: The current study did not exhibit benefit of exogenous albumin administration early after non-cardiac surgery on the occurrence of postoperative AKI in patients with preoperative hypoalbuminemia, which needs to be confirmed by further large randomized controlled researches in the future.

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Expert consensus on the use of human serum albumin in critically ill patients

Cited by 36 publications

References 139 publications

A simple nomogram for predicting infectious diseases in adult kidney transplantation recipients

A simple nomogram for predicting infectious diseases in adult kidney transplantation recipients

Recent advances in critical care: Part II

The Effects of Administration of Exogenous Albumin Early after Non-cardiac Surgery on Postoperative AKI in Patients with Preoperative Hypoalbuminemia: A Prospective Propensity-score Matching Analysis

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