• Am. J. Med. Sci. · Dec 2024

    Relationship between fluid bolus administration and the prognostic role of serum albumin in patients with sepsis.

    • Gianni Turcato, Lucia Filippi, Arian Zaboli, Paolo Ferretto, Daniela Milazzo, Michael Maggi, Francesca Stefani, Marta Parodi, Massimo Marchetti, and Christian J Wiedermann.
    • Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy; UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy. Electronic address: gianni.turcato@yahoo.it.
    • Am. J. Med. Sci. 2024 Dec 3.

    BackgroundSerum albumin plays a pivotal role in the exchange between interstitial and vascular compartments, and reduced levels of this biomarker appear to be associated with negative prognosis in septic patients. The correlation between the volume effect in sepsis therapy and the kinetics of serum albumin is unclear.AimTo investigate the relationship between serum albumin and fluid bolus in relation to its prognostic role in septic patients.MethodsA single-center prospective observational study conducted from September 2022 to February 2024. All patients with sepsis admitted from the Emergency Department to the Intermediate Medical Care Unit (IMCU) were considered. Post-fluid bolus serum albumin was obtained after fluid bolus. The albumin value was correlated with the volume effect of the fluid bolus, and multivariate models were performed to evaluate its potential independent effect on 30-day mortality.Results179 patients were enrolled. Pre-fluid bolus serum albumin was 2.55 g/dL (SD 0.51) with a multivariate OR for 30-day mortality of 1.170 (95 % CI 1.055-1.297, p = 0.003). After the fluid bolus, which resulted in a fluid balance percentage of +23.1 % (SD 7.1) and a mean Fractional Plasma Dilution of -0.48 (SD 0.18), albumin showed a mean decrease of -0.28 g/dL (SD 0.28) with a multivariate OR for 30-day mortality of 1.198 (95 % CI 1.065-1.348, p = 0.003). Post-fluid bolus albumin was negatively correlated with cumulative fluid balance and hemodilution.ConclusionsThe volume effect of fluid bolus is correlated with a decrease in serum albumin, and low albumin levels are associated with a high risk of mortality.Copyright © 2024. Published by Elsevier Inc.

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