Albumin

Critically Ill Patients

• The SAFE (NEJM 2004) study randomized ICU patients requiring IV fluids to albumin or saline.
  • There were no differences in all-cause mortality.
  • Albumin was associated with worse outcomes in patients with TBI
  • There was a non-significant trend towards mortality benefit with albumin use in patients with severe sepsis.

Severe Sepsis and Septic Shock

• The ALBIOS (NEJM 2014) study randomized patients with severe sepsis to 20% albumin + crystalloid solution vs crystalloids alone.
  • Target albumin level was >30 g/L in those in the albumin arm, until ICU discharge or 28 days after randomization
  • Outcomes: in the first 7 days, the albumin arm had a higher MAP and a lower net fluid balance. No difference in 28-d mortality, 90-d mortality.
  • Those treated with albumin had more favorable SOFA subscores and received fewer vasopressors or inotropes.

Decompensated Cirrhosis

• The ATTIRE (NEJM 2021) trial randomized patients with decompensated cirrhosis with serum albumin < 30 g/L to targeted 20% albumin for up to 14d or standard care.
  • Target albumin level was ≥30 g/L
  • There was no difference in the primary outcome of new infection, renal dysfunction, or death between days 3-15 after initiation of treatment.
  • There were more adverse events in the albumin group than in the standard-care group