Albumin in sepsis - Update on the results from the Albios study

Background Although previous studies have suggested potential advantages of albumin administration in severe sepsis, its efficacy has not been fully elucidated. Methods In this multicenter, open-label trial, 1818 patients with severe sepsis admitted to 100 intensive care units (ICUs) were randomly assigned to receive either 20% albumin and crystalloids or crystalloids alone for volume replacement until ICU discharge or 28 days after randomization. Primary outcomes were survival at 28 and 90 days. Results During the first 7 days, patients in the Albumin group showed higher mean arterial (P = 0.03) and central venous pressures (P = 0.001), and a lower net fluid balance (P<0.001), than the Crystalloid group. At 28 days, 285 of 895 patients (31.8%) in the Albumin group and 288 of 900 patients (32.0%) in the Crystalloid group died (relative risk in the Albumin group, 1.00; 95% confidence interval [CI], 0.87 to 1.14; P = 0.94). At 90 days, 365 of 888 patients (41.1%) in the Albumin group and 389 of 893 patients (43.6%) in the Crystalloid group died (relative risk, 0.94; 95% CI, 0.85 to 1.05; P = 0.29). Post-hoc analysis documented heterogeneity between patients with septic shock (n = 1303; relative risk, 0.88; 95% CI, 0.78 to 0.99; P = 0.03) and those without septic shock (n = 478; relative risk, 1.25; 95% CI, 0.97 to 1.61; P = 0.09) at randomization. Conclusions In patients with severe sepsis, fluid resuscitation with albumin and crystalloids as compared to crystalloids alone did not improve 28 and 90-day survival.