20 percent albumin bests plasmalyte for reversing sepsis-induced hypotension in cirrhosis patients

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