Albumin replacement in patients with severe sepsis or septic shock

Andrea Cortegiani, Santi Maurizio Raineri, Antonino Giarratano, Serge Masson, Gilberto Fiore, Giacomo Grasselli, Roberto Fumagalli, Vieri Parrini, Luisa Caspani, Pietro Caironi, Stefano Faenza, Roberto Latini, Gaetano Iapichino, Luciano Gattinoni, Antonio Pesenti, Massimo Antonelli, Gianni Tognoni, Marilena Romero, Caterina Fanizza

Risultato della ricerca: Article

442 Citazioni (Scopus)

Abstract

BACKGROUND: Although previous studies have suggested the potential advantages of albumin administration in patients with severe sepsis, its efficacy has not been fully established.METHODS:In this multicenter, open-label trial, we randomly assigned 1818 patients with severe sepsis, in 100 intensive care units (ICUs), to receive either 20% albumin and crystalloid solution or crystalloid solution alone. In the albumin group, the target serum albumin concentration was 30 g per liter or more until discharge from the ICU or 28 days after randomization. The primary outcome was death from any cause at 28 days. Secondary outcomes were death from any cause at 90 days, the number of patients with organ dysfunction and the degree of dysfunction, and length of stay in the ICU and the hospital.RESULTS:During the first 7 days, patients in the albumin group, as compared with those in the crystalloid group, had a higher mean arterial pressure (P=0.03) and lower net fluid balance (P<0.001). The total daily amount of administered fluid did not differ significantly between the two groups (P=0.10). At 28 days, 285 of 895 patients (31.8%) in the albumin group and 288 of 900 (32.0%) in the crystalloid group had 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 (43.6%) in the crystalloid group had died (relative risk, 0.94; 95% CI, 0.85 to 1.05; P=0.29). No significant differences in other secondary outcomes were observed between the two groups.CONCLUSIONS:In patients with severe sepsis, albumin replacement in addition to crystalloids, as compared with crystalloids alone, did not improve the rate of survival at 28 and 90 days.
Lingua originaleEnglish
pagine (da-a)1412-1421
Numero di pagine10
RivistaNew England Journal of Medicine
Volume370
Stato di pubblicazionePublished - 2014

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Septic Shock
Albumins
Sepsis
Intensive Care Units
Cause of Death
Confidence Intervals
Water-Electrolyte Balance
Random Allocation
crystalloid solutions
Serum Albumin
Length of Stay
Arterial Pressure
Survival Rate

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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Albumin replacement in patients with severe sepsis or septic shock. / Cortegiani, Andrea; Raineri, Santi Maurizio; Giarratano, Antonino; Masson, Serge; Fiore, Gilberto; Grasselli, Giacomo; Fumagalli, Roberto; Parrini, Vieri; Caspani, Luisa; Caironi, Pietro; Faenza, Stefano; Latini, Roberto; Iapichino, Gaetano; Gattinoni, Luciano; Pesenti, Antonio; Antonelli, Massimo; Tognoni, Gianni; Romero, Marilena; Fanizza, Caterina.

In: New England Journal of Medicine, Vol. 370, 2014, pag. 1412-1421.

Risultato della ricerca: Article

Cortegiani, A, Raineri, SM, Giarratano, A, Masson, S, Fiore, G, Grasselli, G, Fumagalli, R, Parrini, V, Caspani, L, Caironi, P, Faenza, S, Latini, R, Iapichino, G, Gattinoni, L, Pesenti, A, Antonelli, M, Tognoni, G, Romero, M & Fanizza, C 2014, 'Albumin replacement in patients with severe sepsis or septic shock', New England Journal of Medicine, vol. 370, pagg. 1412-1421.
Cortegiani, Andrea ; Raineri, Santi Maurizio ; Giarratano, Antonino ; Masson, Serge ; Fiore, Gilberto ; Grasselli, Giacomo ; Fumagalli, Roberto ; Parrini, Vieri ; Caspani, Luisa ; Caironi, Pietro ; Faenza, Stefano ; Latini, Roberto ; Iapichino, Gaetano ; Gattinoni, Luciano ; Pesenti, Antonio ; Antonelli, Massimo ; Tognoni, Gianni ; Romero, Marilena ; Fanizza, Caterina. / Albumin replacement in patients with severe sepsis or septic shock. In: New England Journal of Medicine. 2014 ; Vol. 370. pagg. 1412-1421.
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title = "Albumin replacement in patients with severe sepsis or septic shock",
abstract = "BACKGROUND: Although previous studies have suggested the potential advantages of albumin administration in patients with severe sepsis, its efficacy has not been fully established.METHODS:In this multicenter, open-label trial, we randomly assigned 1818 patients with severe sepsis, in 100 intensive care units (ICUs), to receive either 20{\%} albumin and crystalloid solution or crystalloid solution alone. In the albumin group, the target serum albumin concentration was 30 g per liter or more until discharge from the ICU or 28 days after randomization. The primary outcome was death from any cause at 28 days. Secondary outcomes were death from any cause at 90 days, the number of patients with organ dysfunction and the degree of dysfunction, and length of stay in the ICU and the hospital.RESULTS:During the first 7 days, patients in the albumin group, as compared with those in the crystalloid group, had a higher mean arterial pressure (P=0.03) and lower net fluid balance (P<0.001). The total daily amount of administered fluid did not differ significantly between the two groups (P=0.10). At 28 days, 285 of 895 patients (31.8{\%}) in the albumin group and 288 of 900 (32.0{\%}) in the crystalloid group had 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 (43.6{\%}) in the crystalloid group had died (relative risk, 0.94; 95{\%} CI, 0.85 to 1.05; P=0.29). No significant differences in other secondary outcomes were observed between the two groups.CONCLUSIONS:In patients with severe sepsis, albumin replacement in addition to crystalloids, as compared with crystalloids alone, did not improve the rate of survival at 28 and 90 days.",
author = "Andrea Cortegiani and Raineri, {Santi Maurizio} and Antonino Giarratano and Serge Masson and Gilberto Fiore and Giacomo Grasselli and Roberto Fumagalli and Vieri Parrini and Luisa Caspani and Pietro Caironi and Stefano Faenza and Roberto Latini and Gaetano Iapichino and Luciano Gattinoni and Antonio Pesenti and Massimo Antonelli and Gianni Tognoni and Marilena Romero and Caterina Fanizza",
year = "2014",
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TY - JOUR

T1 - Albumin replacement in patients with severe sepsis or septic shock

AU - Cortegiani, Andrea

AU - Raineri, Santi Maurizio

AU - Giarratano, Antonino

AU - Masson, Serge

AU - Fiore, Gilberto

AU - Grasselli, Giacomo

AU - Fumagalli, Roberto

AU - Parrini, Vieri

AU - Caspani, Luisa

AU - Caironi, Pietro

AU - Faenza, Stefano

AU - Latini, Roberto

AU - Iapichino, Gaetano

AU - Gattinoni, Luciano

AU - Pesenti, Antonio

AU - Antonelli, Massimo

AU - Tognoni, Gianni

AU - Romero, Marilena

AU - Fanizza, Caterina

PY - 2014

Y1 - 2014

N2 - BACKGROUND: Although previous studies have suggested the potential advantages of albumin administration in patients with severe sepsis, its efficacy has not been fully established.METHODS:In this multicenter, open-label trial, we randomly assigned 1818 patients with severe sepsis, in 100 intensive care units (ICUs), to receive either 20% albumin and crystalloid solution or crystalloid solution alone. In the albumin group, the target serum albumin concentration was 30 g per liter or more until discharge from the ICU or 28 days after randomization. The primary outcome was death from any cause at 28 days. Secondary outcomes were death from any cause at 90 days, the number of patients with organ dysfunction and the degree of dysfunction, and length of stay in the ICU and the hospital.RESULTS:During the first 7 days, patients in the albumin group, as compared with those in the crystalloid group, had a higher mean arterial pressure (P=0.03) and lower net fluid balance (P<0.001). The total daily amount of administered fluid did not differ significantly between the two groups (P=0.10). At 28 days, 285 of 895 patients (31.8%) in the albumin group and 288 of 900 (32.0%) in the crystalloid group had 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 (43.6%) in the crystalloid group had died (relative risk, 0.94; 95% CI, 0.85 to 1.05; P=0.29). No significant differences in other secondary outcomes were observed between the two groups.CONCLUSIONS:In patients with severe sepsis, albumin replacement in addition to crystalloids, as compared with crystalloids alone, did not improve the rate of survival at 28 and 90 days.

AB - BACKGROUND: Although previous studies have suggested the potential advantages of albumin administration in patients with severe sepsis, its efficacy has not been fully established.METHODS:In this multicenter, open-label trial, we randomly assigned 1818 patients with severe sepsis, in 100 intensive care units (ICUs), to receive either 20% albumin and crystalloid solution or crystalloid solution alone. In the albumin group, the target serum albumin concentration was 30 g per liter or more until discharge from the ICU or 28 days after randomization. The primary outcome was death from any cause at 28 days. Secondary outcomes were death from any cause at 90 days, the number of patients with organ dysfunction and the degree of dysfunction, and length of stay in the ICU and the hospital.RESULTS:During the first 7 days, patients in the albumin group, as compared with those in the crystalloid group, had a higher mean arterial pressure (P=0.03) and lower net fluid balance (P<0.001). The total daily amount of administered fluid did not differ significantly between the two groups (P=0.10). At 28 days, 285 of 895 patients (31.8%) in the albumin group and 288 of 900 (32.0%) in the crystalloid group had 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 (43.6%) in the crystalloid group had died (relative risk, 0.94; 95% CI, 0.85 to 1.05; P=0.29). No significant differences in other secondary outcomes were observed between the two groups.CONCLUSIONS:In patients with severe sepsis, albumin replacement in addition to crystalloids, as compared with crystalloids alone, did not improve the rate of survival at 28 and 90 days.

UR - http://hdl.handle.net/10447/100967

M3 - Article

VL - 370

SP - 1412

EP - 1421

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

ER -