by Park,
Clarice Hyesuk Lee; de Almeida, Juliano Pinheiro; de Oliveira, Gisele Queiroz;
Rizk, Stéphanie Itala; Fukushima, Julia Tizue; Nakamura, Rosana Ely; Mourão,
Matheus Moraes; Galas, Filomena Regina Barbosa Gomes; Abdala, Edson; Pinheiro
Freire, Maristela; Kalil Filho, Roberto; Costa Auler, Jose Otavio Jr; Nardelli,
Pasquale; Martin, Greg S.; Landoni, Giovanni; Hajjar, Ludhmila Abrahao
Objective: To investigate the effects of the administration of 4% albumin on
lactated Ringer’s, when compared with lactated Ringer’s alone, in the early
phase of sepsis in cancer patients.
Design: Single-center, randomized, double-blind, controlled-parallel trial.
Setting: A tertiary care university cancer hospital.
Patients: Cancer patients with severe sepsis or septic shock. Interventions:
Between October 2014 and December 2016, patients were randomly assigned to
receive either bolus of albumin in a lactated Ringer’s solution or lactated
Ringer’s solution alone during the first 6 hours of fluid resuscitation after
intensive care medicine (ICU) admission. Primary outcome was defined as death
from any cause at 7 days. Secondary outcomes were defined as death from any
cause within 28 days, change in Sequence Organ Failure Assessment scores from
baseline to day 7, days alive and free of mechanical ventilation, days alive
and free of vasopressor, renal replacement therapy during ICU stay, and length
of ICU and hospital stay.
Measurements and Main Results: A total of 360 patients were enrolled in the
trial. At 7 days, 46 of 180 patients (26%) died in the albumin group and 40 of
180 (22%) died in the lactated Ringer’s group (p = 0.5). At 28 days, 96 of 180
patients (53%) died in the albumin group and 83 of 180 (46%) died in the
lactated Ringer’s group (p = 0.2). No significant differences in secondary
outcomes were observed.
Conclusions: Adding albumin to early standard resuscitation
with lactated Ringer’s in cancer patients with sepsis did not improve 7-day
survival.
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