Is albumin superior to plasmalyte in cirrhosis, sepsis-induced hypotension?

Use of 20% albumin in patients with cirrhosis and sepsis-induced hypotension results in faster improvement in haemodynamics and lactate clearance than plasmalyte, but 28-day survival is similar, according to a study.

“However, patients on 20% albumin need to be closely monitored as it was more often associated with pulmonary complications,” the researchers said.

In this study, 100 critically ill patients with cirrhosis were randomized to receive either 20% albumin (0.5‒1.0 g/kg over 3 hours; n=50) or plasmalyte (30 ml/kg over 3 hours; n=50). The attainment of mean arterial pressure (MAP) >65 mm Hg at 3 hours was the primary endpoint.

Patients in the albumin and plasmalyte groups had similar baseline characteristics: arterial lactate (6.16 vs 6.38 mmol/L; p=0.78), MAP (51.4 vs 49.9 mm Hg; p=0.17), and SOFA score (10.8 vs 11.1; p=0.68). Most patients were alcoholic (39 percent) and had pneumonia (40 percent).

Intention-to-treat analysis revealed that albumin was superior to plasmalyte in achieving the primary endpoint (62 percent vs 22 percent; p<0.001). Patients on albumin had a faster decrease in arterial lactate (p=0.03), a reduced need for dialysis (48 percent vs 62 percent; p=0.16), and a longer time to initiation of dialysis (68.13 vs 99.63 h; p=0.06).

However, 29-day mortality was comparable between groups (58 percent vs 62 percent; p=0.57). In addition, 11 patients (22 percent) in the albumin group discontinued treatment due to adverse events; none of those in the plasmalyte group ceased treatment.