20 percent albumin bests plasmalyte for reversing sepsis-induced hypotension in cirrhosis patients
Aizawl: A new article published in the Journal of Hepatology showed that in individuals with cirrhosis and sepsis-induced hypotension, 20% albumin improves hemodynamics and lactate clearance faster than plasmalyte. 28-day survival was similar in both the groups and patients on 20% albumin experienced more pulmonary complications.
It is uncertain which resuscitation fluid should be used in individuals with cirrhosis and sepsis-induced hypotension. In the FRISC research, 5% albumin outperformed normal saline. Rakhi Maiwall and colleagues undertook this study to assess the effectiveness and safety of 20% albumin, which has stronger oncotic characteristics, to plasmalyte in treating sepsis-induced hypotension.
For this research critically sick cirrhotic patients were randomly assigned to receive either plasmalyte (30 ml/kg over 3 hours; n = 50) or 20% albumin (0.5-1.0 g/kg over 3 hours; n = 50). The primary goal of the study was to achieve a mean arterial pressure (MAP) greater than 65 mmHg after 3 hours.
The key findings of this study were as follows:
1. The baseline parameters of the albumin and plasmalyte groups, as well as arterial lactate, MAP, and SOFA score, were equivalent.
2. The majority of patients (39%) were alcoholics with pneumonia (40% ).
3. In the intention-to-treat study, albumin outperformed plasmalyte in terms of meeting the main outcome.
4. Albumin was associated with a quicker fall in arterial lactate, a lower requirement for dialysis, and a longer delay to dialysis beginning (in hours).
5. However, the 28-day mortality rate was not different, and therapy had to be terminated in 11 (22%) of the albumin group due to side effects, but there were no discontinuations in the plasmalyte group.
In conclusion, this study indicated that albumin outperformed plasmalyte in terms of a quick improvement in microcirculation, lactate clearance, and shock reversal, but at the expense of a higher risk of pulmonary consequences. However, there were no differences in overall clinical outcomes improvement. Future RCTs should look at whether combining gradual albumin infusion with plasmalyte is a superior method.
Reference:
Maiwall, R., Kumar, A., Pasupuleti, S. S. R., Hidam, A. K., Tevethia, H., Kumar, G., Sahney, A., Mitra, L. G., & Sarin, S. K. (2022). A randomized-controlled trial comparing 20% albumin to plasmalyte in patients with cirrhosis and sepsis-induced hypotension [ALPS trial]. In Journal of Hepatology. Elsevier BV. https://doi.org/10.1016/j.jhep.2022.03.043
Disclaimer: This website is primarily for healthcare professionals. The content here does not replace medical advice and should not be used as medical, diagnostic, endorsement, treatment, or prescription advice. Medical science evolves rapidly, and we strive to keep our information current. If you find any discrepancies, please contact us at corrections@medicaldialogues.in. Read our Correction Policy here. Nothing here should be used as a substitute for medical advice, diagnosis, or treatment. We do not endorse any healthcare advice that contradicts a physician's guidance. Use of this site is subject to our Terms of Use, Privacy Policy, and Advertisement Policy. For more details, read our Full Disclaimer here.
NOTE: Join us in combating medical misinformation. If you encounter a questionable health, medical, or medical education claim, email us at factcheck@medicaldialogues.in for evaluation.