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Article Dans Une Revue Critical Care Année : 2024

Albumin versus saline infusion for sepsis-related peripheral tissue hypoperfusion: a proof-of-concept prospective study

Paul Gabarre
  • Fonction : Auteur
Cyrielle Desnos
  • Fonction : Auteur
Alexandra Morin
  • Fonction : Auteur
Louai Missri
  • Fonction : Auteur
Tomas Urbina
  • Fonction : Auteur
Vincent Bonny
  • Fonction : Auteur
Matthieu Turpin
  • Fonction : Auteur
Jean-Luc Baudel
  • Fonction : Auteur
Laurence Berard
  • Fonction : Auteur
Melissa Montil
  • Fonction : Auteur
Bertrand Guidet
  • Fonction : Auteur
Guillaume Voiriot
  • Fonction : Auteur
Jérémie Joffre
  • Fonction : Auteur
Eric Maury
  • Fonction : Auteur

Résumé

Background: Albumin has potential endothelial protective effects through antioxidant and anti-inflammatory properties. However, the effect of albumin on peripheral tissue perfusion in human sepsis remains poorly known.
Methods: Bi-centric prospective study included patients with sepsis with or without shock and prolonged CRT > 3 s despite initial resuscitation. Clinicians in charge of the patients were free to infuse either saline 500 mL or human serum albumin 20% 100 mL over 15 min. Global hemodynamic parameters as well as peripheral tissue perfusion were analyzed after 1 (H1) and 4 h (H4). The primary endpoint was CRT normalization (< 3 s) at H1.
Results: 62 patients were screened, and 50 patients (13 sepsis and 37 septic shock) were included, 21 in the saline group and 29 in the albumin group. SOFA score was 8 [5–11], and SAPS II was 53 [45–70]. Median age was 68 [60–76] years with a higher proportion of men (74%). The primary sources of infection were respiratory (54%) and abdominal (24%). At baseline, comorbidities, clinical and biological characteristics were similar between groups . At H1, CRT normalization (< 3 s) was more frequent in patients receiving albumin as compared to patients treated by saline (63 vs 29%, P = 0.02). The decrease in fingertip CRT was more important in the albumin group when compared to saline group (− 1.0 [− 0.3; − 1.5] vs − 0.2 [− 0.1; − 1.1] seconds, P = 0.04) as well as decrease in mottling score. At H4, beneficial effects of albumin on peripheral tissue perfusion were maintained and urinary output trended to be higher in the albumin group (1.1 [0.5–1.8] vs 0.7 [0.5–0.9] ml/kg/h, P = 0.08). Finally, arterial lactate level did not significantly change between H0 and H4 in the saline group but significantly decreased in the albumin group ( P = 0.03).
Conclusion: In patients with resuscitated sepsis, albumin infusion might lead to greater improvement of tissue hypoperfusion compared to saline. ClinicalTrials.gov Identifier: NCT05094856.
gov Identifier: NCT05094856.

Dates et versions

hal-04595008 , version 1 (30-05-2024)

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Paul Gabarre, Cyrielle Desnos, Alexandra Morin, Louai Missri, Tomas Urbina, et al.. Albumin versus saline infusion for sepsis-related peripheral tissue hypoperfusion: a proof-of-concept prospective study. Critical Care, 2024, 28 (1), pp.43. ⟨10.1186/s13054-024-04827-0⟩. ⟨hal-04595008⟩

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