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      Effect of albumin on the outcomes in septic patients with hypoalbuminemia in the emergency department: a propensity score-matched retrospective cohort study

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      https://www.riss.kr/link?id=A108329285

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      다국어 초록 (Multilingual Abstract)

      Objective: A low albumin concentration is known to be associated with poor prognosis in patients with sepsis, but the benefits of albumin administration in these patients are unclear. This study was performed to investigate the effect of albumin administration on the outcomes of patients suffering from sepsis or septic shock.
      Methods: This was a retrospective, propensity score-matched cohort study of septic patients with an initial serum albumin level < 3.0 g/dL admitted to the emergency department (ED) of an urban tertiary university hospital. Patients who received 20% albumin within 24 hours of admission to the ED were compared with those who did not. We performed a 1:1 propensity score-matched analysis. The primary outcome was the 28-day mortality rate and the secondary outcomes were the Sequential Organ Failure Assessment (SOFA) score at 24, 48, and 72 hours, the need for mechanical ventilation and renal replacement therapy (RRT), and admission to the intensive care unit (ICU).
      Results: A total of 1,284 patients were included in the study, and the overall mortality rate was 29.4%. After propensity score matching, 192 patients in the albumin group and 192 in the control group were included in the final analysis. There was no significant difference in the 28-day mortality rates. The SOFA scores at 24, 48, and 72 hours were higher in the albumin group than in the control group. The rates of RRT and admission to the ICU were also higher in the albumin group.
      Conclusion: In patients with sepsis and hypoalbuminemia, albumin replacement was not associated with higher 28-day mortality, but was associated with the higher SOFA scores, higher rates of RRT application and admission to the ICU.
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      Objective: A low albumin concentration is known to be associated with poor prognosis in patients with sepsis, but the benefits of albumin administration in these patients are unclear. This study was performed to investigate the effect of albumin admin...

      Objective: A low albumin concentration is known to be associated with poor prognosis in patients with sepsis, but the benefits of albumin administration in these patients are unclear. This study was performed to investigate the effect of albumin administration on the outcomes of patients suffering from sepsis or septic shock.
      Methods: This was a retrospective, propensity score-matched cohort study of septic patients with an initial serum albumin level < 3.0 g/dL admitted to the emergency department (ED) of an urban tertiary university hospital. Patients who received 20% albumin within 24 hours of admission to the ED were compared with those who did not. We performed a 1:1 propensity score-matched analysis. The primary outcome was the 28-day mortality rate and the secondary outcomes were the Sequential Organ Failure Assessment (SOFA) score at 24, 48, and 72 hours, the need for mechanical ventilation and renal replacement therapy (RRT), and admission to the intensive care unit (ICU).
      Results: A total of 1,284 patients were included in the study, and the overall mortality rate was 29.4%. After propensity score matching, 192 patients in the albumin group and 192 in the control group were included in the final analysis. There was no significant difference in the 28-day mortality rates. The SOFA scores at 24, 48, and 72 hours were higher in the albumin group than in the control group. The rates of RRT and admission to the ICU were also higher in the albumin group.
      Conclusion: In patients with sepsis and hypoalbuminemia, albumin replacement was not associated with higher 28-day mortality, but was associated with the higher SOFA scores, higher rates of RRT application and admission to the ICU.

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      참고문헌 (Reference)

      1 Singer M, "The third international consensus definitions for Sepsis and Septic Shock(Sepsis-3)" 315 : 801-810, 2016

      2 Dellinger RP, "Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012" 39 : 165-228, 2013

      3 Rhodes A, "Surviving Sepsis Campaign : international guidelines for management of sepsis and septic shock : 2016" 43 : 304-377, 2017

      4 Lee WL, "Sepsis and endothelial permeability" 363 : 689-691, 2010

      5 Martin-Loeches I, "Risk factors for mortality in elderly and very elderly critically ill patients with sepsis: a prospective, observational, multicenter cohort study" 9 : 26-, 2019

      6 El Iskandarani M, "Prognostic role of albumin level in heart failure: a systematic review and meta-analysis" 100 : e24785-, 2021

      7 Sadaka F, "Predicting mortality of patients with sepsis : a comparison of APACHE II and APACHE III scoring systems" 9 : 907-910, 2017

      8 Claesson-Welsh L, "Permeability of the endothelial barrier : identifying and reconciling con-troversies" 27 : 314-331, 2021

      9 Keller U, "Nutritional Laboratory markers in malnutrition" 8 : 775-, 2019

      10 Hwang YJ, "Newly designed delta neutrophil index-to-serum albumin ratio prognosis of early mortality in severe sepsis" 33 : 1577-1582, 2015

      1 Singer M, "The third international consensus definitions for Sepsis and Septic Shock(Sepsis-3)" 315 : 801-810, 2016

      2 Dellinger RP, "Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012" 39 : 165-228, 2013

      3 Rhodes A, "Surviving Sepsis Campaign : international guidelines for management of sepsis and septic shock : 2016" 43 : 304-377, 2017

      4 Lee WL, "Sepsis and endothelial permeability" 363 : 689-691, 2010

      5 Martin-Loeches I, "Risk factors for mortality in elderly and very elderly critically ill patients with sepsis: a prospective, observational, multicenter cohort study" 9 : 26-, 2019

      6 El Iskandarani M, "Prognostic role of albumin level in heart failure: a systematic review and meta-analysis" 100 : e24785-, 2021

      7 Sadaka F, "Predicting mortality of patients with sepsis : a comparison of APACHE II and APACHE III scoring systems" 9 : 907-910, 2017

      8 Claesson-Welsh L, "Permeability of the endothelial barrier : identifying and reconciling con-troversies" 27 : 314-331, 2021

      9 Keller U, "Nutritional Laboratory markers in malnutrition" 8 : 775-, 2019

      10 Hwang YJ, "Newly designed delta neutrophil index-to-serum albumin ratio prognosis of early mortality in severe sepsis" 33 : 1577-1582, 2015

      11 Gharipour A, "Lactate/albumin ratio : an early prognostic marker in critically ill patients" 38 : 2088-2095, 2020

      12 Yin M, "Ischemia-modified albumin is a predictor of short-term mortality in patients with severe sepsis" 37 : 7-12, 2017

      13 Moseson EM, "Intensive care unit scoring systems outperform emergency department scoring systems for mortality prediction in critically ill patients : a prospective cohort study" 2 : 40-, 2014

      14 Kremer H, "Human serum albumin improves endothelial dysfunction and survival during experimental endotoxemia : concentrationdependent properties" 39 : 1414-1422, 2011

      15 Cochrane Injuries Group Albumin Reviewers, "Human albumin administration in critically ill patients : systematic review of randomised controlled trials" 317 : 235-240, 1998

      16 Williams MD, "Hospitalized cancer patients with severe sepsis : analysis of incidence, mortality, and associated costs of care" 8 : R291-R298, 2004

      17 Vincent JL, "Fluid management in sepsis : the potential beneficial effects of albumin" 35 : 161-167, 2016

      18 Holcroft JW, "Extravasation of albumin in tissues of normal and septic baboons and sheep" 26 : 341-347, 1979

      19 Mendes RS, "Effects of crystalloid, hyper-oncotic albumin, and iso-oncotic albumin on lung and kidney damage in experimental acute lung injury" 20 : 155-, 2019

      20 Pulimood TB, "Debate : albumin administration should be avoided in the critically ill" 4 : 151-155, 2000

      21 Gore DC, "Colloid infusions reduce glomerular filtration in resuscitated burn victims" 40 : 356-360, 1996

      22 Xu J, "Association of sex with clinical outcome in critically ill sepsis patients : a retrospective analysis of the large clinical database MIMIC-III" 52 : 146-151, 2019

      23 Caironi P, "Albumin replacement in patients with severe sepsis or septic shock" 370 : 1412-1421, 2014

      24 Khan N, "Albumin as a prognostic marker for ulcerative colitis" 23 : 8008-8016, 2017

      25 Lang JD Jr, "Albumin and hydroxyethyl starch modulate oxidative inflammatory injury to vascular endothelium" 100 : 51-58, 2004

      26 Quinlan GJ, "Administration of albumin to patients with sepsis syndrome: a possible beneficial role in plasma thiol repletion" 95 : 459-465, 1998

      27 Udeh CI, "Acute kidney injury in postoperative shock: is hyperoncotic albumin administration an unrecognized resuscitation risk factor?" 7 : 29-, 2018

      28 Finfer S, "A comparison of albumin and saline for fluid resuscitation in the intensive care unit" 350 : 2247-2256, 2004

      29 Levy MM, "2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference" 29 : 530-538, 2003

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