Albumin use in patients with septic shock—Post-hoc analyses of an international randomised fluid trial
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Albumin use in patients with septic shock—Post-hoc analyses of an international randomised fluid trial. / Meyhoff, Tine Sylvest; Granholm, Anders; Hjortrup, Peter Buhl; Sivapalan, Praleene; Lange, Theis; Laake, Jon Henrik; Cronhjort, Maria; Jakob, Stephan M.; Cecconi, Maurizio; Nalos, Marek; Ostermann, Marlies; Malbrain, Manu L.N.G.; Møller, Morten Hylander; Perner, Anders.
I: Acta Anaesthesiologica Scandinavica, Bind 68, Nr. 3, 2024, s. 372-384.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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T1 - Albumin use in patients with septic shock—Post-hoc analyses of an international randomised fluid trial
AU - Meyhoff, Tine Sylvest
AU - Granholm, Anders
AU - Hjortrup, Peter Buhl
AU - Sivapalan, Praleene
AU - Lange, Theis
AU - Laake, Jon Henrik
AU - Cronhjort, Maria
AU - Jakob, Stephan M.
AU - Cecconi, Maurizio
AU - Nalos, Marek
AU - Ostermann, Marlies
AU - Malbrain, Manu L.N.G.
AU - Møller, Morten Hylander
AU - Perner, Anders
N1 - Publisher Copyright: © 2023 Acta Anaesthesiologica Scandinavica Foundation.
PY - 2024
Y1 - 2024
N2 - Background: Albumin administration is suggested in patients with sepsis and septic shock who have received large volumes of crystalloids. Given lack of firm evidence, clinical practice variation may exist. To address this, we investigated if patient characteristics or trial site were associated with albumin use in septic shock. Methods: We conducted a post-hoc study of the CLASSIC international, randomised clinical trial of fluid volumes in septic shock. Associations between selected baseline variables and trial site with albumin use during ICU stay were assessed in Cox models considering death, ICU discharge, and loss-to-follow-up as competing events. Baseline variables were first assessed individually, adjusted for treatment allocation (restrictive vs. standard IV fluid), and then adjusted for allocation and the other baseline variables. Site was assessed in a model adjusted for allocation and baseline variables. Results: We analysed 1541 of 1554 patients randomised in CLASSIC (99.2%). During ICU stay, 36.3% of patients in the restrictive-fluid group and 52.6% in the standard-fluid group received albumin. Gastrointestinal focus of infection and higher doses of norepinephrine were most strongly associated with albumin use (subgroup with highest quartile of norepinephrine doses, hazard ratio (HR) 2.58, 95% CI 1.89 to 3.53). HRs for associations between site and albumin use ranged from 0.11 (95% CI 0.05 to 0.26) to 1.70 (95% CI 1.06 to 2.74); test for overall effect of site: p <.001. Conclusions: In adults with septic shock, gastrointestinal focus of infection and higher doses of norepinephrine at baseline were associated with albumin use, which also varied substantially between sites.
AB - Background: Albumin administration is suggested in patients with sepsis and septic shock who have received large volumes of crystalloids. Given lack of firm evidence, clinical practice variation may exist. To address this, we investigated if patient characteristics or trial site were associated with albumin use in septic shock. Methods: We conducted a post-hoc study of the CLASSIC international, randomised clinical trial of fluid volumes in septic shock. Associations between selected baseline variables and trial site with albumin use during ICU stay were assessed in Cox models considering death, ICU discharge, and loss-to-follow-up as competing events. Baseline variables were first assessed individually, adjusted for treatment allocation (restrictive vs. standard IV fluid), and then adjusted for allocation and the other baseline variables. Site was assessed in a model adjusted for allocation and baseline variables. Results: We analysed 1541 of 1554 patients randomised in CLASSIC (99.2%). During ICU stay, 36.3% of patients in the restrictive-fluid group and 52.6% in the standard-fluid group received albumin. Gastrointestinal focus of infection and higher doses of norepinephrine were most strongly associated with albumin use (subgroup with highest quartile of norepinephrine doses, hazard ratio (HR) 2.58, 95% CI 1.89 to 3.53). HRs for associations between site and albumin use ranged from 0.11 (95% CI 0.05 to 0.26) to 1.70 (95% CI 1.06 to 2.74); test for overall effect of site: p <.001. Conclusions: In adults with septic shock, gastrointestinal focus of infection and higher doses of norepinephrine at baseline were associated with albumin use, which also varied substantially between sites.
U2 - 10.1111/aas.14359
DO - 10.1111/aas.14359
M3 - Journal article
C2 - 37975538
AN - SCOPUS:85177056970
VL - 68
SP - 372
EP - 384
JO - Acta Anaesthesiologica Scandinavica
JF - Acta Anaesthesiologica Scandinavica
SN - 0001-5172
IS - 3
ER -
ID: 374889054