Impact of Early Albumin Use for Resuscitation in Patients With Septic Shock and Cirrhosis

Background: The choice of resuscitation fluid remains debated for patients with septic shock. While patients with cirrhosis may benefit from albumin administration, the efficacy of albumin for resuscitation in cirrhotic patients with septic shock remains unclear. Methods: This is a historical cohort study of patients with cirrhosis admitted for septic shock to the intensive care unit (ICU) at a tertiary referral hospital from January 2007 to May 2017. Patients were stratified based on using albumin for fluid resuscitation within six hours of ICU admission. The primary outcome was the percentage of time during the first 48 h of ICU admission that patients were alive and shock-free. Linear regression was used to compare this outcome between groups, and a multivariable analysis was performed to account for baseline differences between study populations. Results: Of the 132 patients with cirrhosis admitted for septic shock, albumin was administered within the first six hours of ICU admission for 84 patients (64%). The albumin and nonalbumin groups had similar percentages of shock-free time during the first 48 h of ICU admission (9.0% vs. 20.2%, p = 0.073) and ICU length of stay (5.6 vs. 3.7 days, p = 0.093). No differences were observed in clinical outcomes of end-organ dysfunction, such as the need for kidney replacement therapy or mechanical ventilation. Conclusion: Administration of albumin during the first 6 h of ICU admission as an adjunctive resuscitation fluid to crystalloids was not associated with improved shock-free time in the ICU or clinical outcomes in patients with cirrhosis and septic shock.