Albumin Versus Gelatin Solution for the Treatment of Refractory Septic Shock: A Patient Baseline-Matched-Cohort Study

Surat  Tongyoo; Chawanee  Chayakul; Siwanat  Kanoknatsiwattana; Chairat  Permpikul

doi:10.33192/Smj.2020.61

Authors

Surat Tongyoo Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok http://orcid.org/0000-0003-3772-2990
Chawanee Chayakul Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Siwanat Kanoknatsiwattana Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Chairat Permpikul Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok http://orcid.org/0000-0001-5491-6987

DOI:

https://doi.org/10.33192/Smj.2020.61

Keywords:

Septic shock, colloid solution, albumin solution, gelatin solution, crystalloid solution, fluid resuscitation

Abstract

Objective: Although albumin solution is the colloid of choice to resuscitate septic shock patients who do not respond to crystalloid solutions, its usage is limited by its cost. Gelatin solution, is less expensive, but its efficacy has not yet been identified. This study aimed to compare the outcomes of gelatin and albumin solutions for septic shock resuscitation.
Methods: This baseline-matched-cohort study, enrolled septic shock patients who had a mean arterial blood pressure (MAP) below 65 mmHg after receiving at least 30 mL per kilogram of crystalloid resuscitation fluid, and who required either an albumin or gelatin solution as fluid therapy. The primary outcome was the 28-day mortality.
Results: In all, 224 patients who were administered either an albumin or gelatin solution were examined. After adjusting for differences in their baseline characteristics, 206 patients were included (104 receiving albumin, and 102 given gelatin). A comparison of the albumin and gelatin groups revealed no significant baseline differences in their respective mean APACHE II scores (22.8±8.5vs.23.2±8.1), MAPs (55.1±8.0vs.54.6±9.1mmHg), and lactate levels (5.6±4.7vs.6.3±4.9mmol/L). The 28-day mortality rates were 27.9% and 38.2% for the albumin and gelatin groups, respectively, with adjusted p=0.02. Moreover, the accumulation of fluid intake over output at 72 hours was significantly lower for the albumin than the gelatin group (5,964.5±4,959.7 vs. 8,133.2±3,743.2 ml; p=0.01). The RRT rate was higher for the albumin group (30.8% vs. 15.7%; p=0.01).
Conclusion: Albumin resuscitation associated with lower 28-day mortality than gelatin resuscitation. The patients in the albumin group had a higher RRT rate and a lower fluid accumulation as at 72 hours.

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