Sepsis Brazil – early results: albumin and mortality rate in septic shock

Introduction

The fluid replacement therapy in septic shock is a polemic issue, regarding the use of crystalloid versus colloid solutions. Albumin is the more often used colloid solution. A recently published study (SAFE study) showed no benefits in albumin versus crystalloid use, for fluid replacement in shock patients.

Objective

To analyse the septic shock subgroup in our study, regarding the use of albumin as a fluid replacement solution and its influence on mortality.

Patients and methods

We conducted a prospective cohort study in 50 hospitals of all regions of Brazil. The patients who were admitted or who developed sepsis during the month of September 2003 were enrolled. They were followed until the 28th day or less according to their discharge. The diagnoses were made in accordance with the criteria proposed by ACCP/SCCM. We evaluated demographic features, APACHE II, Sepsis-related Organ Failure Assessment (SOFA) score, mortality, sources of infections, microbiology and interventions. We also recorded underlying diseases and length of stay.

Results

A total of 2419 patients were identified and 409 (16.9%) filled the criteria of sepsis, severe sepsis or septic shock. Two hundred and ten patients (51.4%) formed the septic shock subgroup, with a mean APACHE II score of 22 and a overall mortality rate of 63.8%. Eighty-five patients (40.5%) in this subgroup used albumin; 125 patients (59.5%) did not. Fifty-one patients (60%) in the albumin group died; 34 (40%) were alive on the 28th day. In the non-albumin septic shock patients subgroup, one patient (0.8%) was transferred from the hospital and excluded from the study; 83 patients (66.4%) died and 41 (32.8%) were still alive after 28 days.

When we apply the binomial probability test, the mortality rate in the albumin group is 66.93% versus 60% in the non-albumin group. Using 60% as the expected mortality rate for both subgroups (because it is the little one), P = 0.05. In the albumin subgroup we had 44 females and 41 males; in the non-albumin subgroup, 50 females and 75 males. The mean age and APACHE II score were the same in both subgroups (61.98 years old and 20.88, respectively).

Conclusions

We can see a trend towards not using albumin as a fluid replacement solution in septic shock patients, a standard therapy previously. Albumin really seems not to be a protective therapy for these patients, since the mortality rate in both groups (albumin and non-albumin users) are too close (actually, when the statistical test is applied, we see a trend towards a greater mortality rate in the albumin subgroup).