Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2021 Jan 1;49(1):79-90.
doi: 10.1097/CCM.0000000000004706.

Effects of 5% Albumin Plus Saline Versus Saline Alone on Outcomes From Large-Volume Resuscitation in Critically Ill Patients

Hernando Gomez  1   2 , Priyanka Priyanka  1 , Ayham Bataineh  1   3 , Christopher M Keener  1 , Gilles Clermont  2 , John A Kellum  1   2   3
Affiliations
Observational Study

Effects of 5% Albumin Plus Saline Versus Saline Alone on Outcomes From Large-Volume Resuscitation in Critically Ill Patients

Hernando Gomez et al. Crit Care Med. .

Abstract

Objectives: To compare 5% albumin with 0.9% saline for large-volume resuscitation (> 60 mL/Kg within 24 hr), on mortality and development of acute kidney injury.

Design: Retrospective cohort study.

Setting: Patients admitted to ICUs in 13 hospitals across Western Pennsylvania. We analyzed two independent cohorts, the High-Density Intensive Care databases: High-Density Intensive Care-08 (July 2000 to October 2008, H08) and High-Density Intensive Care-15 (October 2008 to December 2014, H15).

Patients: Total of 18,629 critically ill patients requiring large-volume resuscitation.

Interventions: Five percent of albumin in addition to saline versus 0.9% saline.

Measurements and main results: After excluding patients with acute kidney injury prior to large-volume resuscitation, 673 of 2,428 patients (27.7%) and 1,814 of 16,201 patients (11.2%) received 5% albumin in H08 and H15, respectively. Use of 5% albumin was associated with decreased 30-day mortality by multivariate regression in H08 (odds ratio 0.65; 95% CI 0.49-0.85; p = 0.002) and in H15 (0.52; 95% CI 0.44-0.62; p < 0.0001) but was associated with increased acute kidney injury in H08 (odds ratio 1.98; 95% CI 1.56-2.51; p < 0.001) and in H15 (odds ratio 1.75; 95% CI 1.58-1.95; p < 0.001). However, 5% albumin was not associated with persistent acute kidney injury and resulted in decreased major adverse kidney event at 30, 90, and 365 days. Propensity matched analysis confirmed similar associations with mortality and acute kidney injury.

Conclusions: During large-volume resuscitation, 5% albumin was associated with reduced mortality and major adverse kidney event at 30, 90, and 365 days. However, a higher rate of acute kidney injury of any stage was observed that did not translate into persistent renal dysfunction.

Trial registration: ClinicalTrials.gov NCT02641119.

PubMed Disclaimer

Conflict of interest statement

Dr. Gomez’s institution received funding from the National Institutes of Health (NIH)/National Institute of General Medical Sciences K08 grant 1K08GM117310-01A1 and TES Pharma. Drs. Gomez, Bataineh, Clermont, and Kellum received support for article research from the NIH. Drs. Bataineh’s and Kellum’s institutions received funding from Grifols and the NIH. Dr. Clermont received funding from the NIH and the National Science Foundation, and he disclosed that he is also Chief Medical Officer and owns equity in NOMA AI Inc. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1:
Figure 1:
CONSORT diagram for HiDenIC08 (A), and HiDenIC15 (B).
Figure 1:
Figure 1:
CONSORT diagram for HiDenIC08 (A), and HiDenIC15 (B).
Figure 2:
Figure 2:
Adjusted survival (cox model) by treatment group in HiDenIC15
See this image and copyright information in PMC

References

    1. Quinlan GJ, Martin GS, Evans TW. Albumin: biochemical properties and therapeutic potential. Hepatology. 2005;41(6):1211–1219. - PubMed
    1. Woodcock TE, Woodcock TM. Revised Starling equation and the glycocalyx model of transvascular fluid exchange: an improved paradigm for prescribing intravenous fluid therapy. British Journal of Anaesthesia. 2012;108(3):384–394. - PubMed
    1. Hahn RG, Lyons G. The half-life of infusion fluids: An educational review. Eur J Anaesthesiol. 2016;33(7):475–482. - PMC - PubMed
    1. Nicholson JP, Wolmarans MR, Park GR. The role of albumin in critical illness. Br J Anaesth. 2000;85(4):599–610. - PubMed
    1. Fleck A, Raines G, Hawker F, et al. Increased vascular permeability: a major cause of hypoalbuminaemia in disease and injury. Lancet. 1985;1(8432):781–784. - PubMed

Publication types

Associated data