Septic shock-3 vs 2: an analysis of the ALBIOS study

Critical Care

Luigi Camporota¹  Pietro Caironi²  Federica Romitti³  Iacopo Pasticci³  Francesco Vasques³  Eleonora Duscio³  Luciano Gattinoni³  Michael Quintel³  Roberto Latini⁴  Jennifer Meessen⁴  Roberto Fumagalli⁵  Antonio Pesenti⁵  Massimo Cressoni⁶ 

[1] Department of Adult Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, King’s Health Partners, and Division of Asthma, Allergy and Lung Biology, King’s College London;Department of Anesthesia and Critical Care, Azienda-Ospedaliero Universitaria S. Luigi Gonzaga;Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen;Department of Cardiovascular Research, IRCCS - Istituto di Ricerche Farmacologiche “Mario Negri”;Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico;Dipartimento di Scienze della Salute, Università degli Studi di Milano;

关键词: Septic shock;    Shock-3;    Sepsis;    Albumin;    Crystalloids;    ALBIOS;   

DOI  :  10.1186/s13054-018-2169-8

来源: DOAJ

【 摘 要 】

Abstract Background A reanalysis of the ALBIOS trial suggested that patients with septic shock - defined by vasopressor-dependent hypotension in the presence of severe sepsis (Shock-2) - had a survival benefit when treated with albumin. The new septic shock definition (Shock-3) added the criterion of a lactate threshold of 2 mmol/L. We investigated how the populations defined according to Shock-2 and Shock-3 differed and whether the albumin benefit would be confirmed. Methods This is a retrospective analysis of the ALBIOS study, a randomized controlled study conducted between 2008 and 2012 in 100 intensive care units in Italy comparing the administration of 20% albumin and crystalloids versus crystalloids alone in patients with severe sepsis or septic shock. We analyzed data from 1741 patients from ALBIOS with serum lactate measurement available at baseline. We compared group size, physiological variables and 90-day mortality between patients defined by Shock-2 and Shock-3 and between the albumin and crystalloid treatment groups. Results We compared the Shock-2 and the Shock-3 definitions and the albumin and crystalloid treatment groups in terms of group size and physiological, laboratory and outcome variables. The Shock-3 definition reduced the population with shock by 34%. The Shock-3 group had higher lactate (p < 0.001), greater resuscitation-fluid requirement (p = 0.014), higher Simplified Acute Physiology Score II (p < 0.001) and Sepsis-related Organ Failure Assessment scores (p = 0.022), lower platelet count (p = 0.002) and higher 90-day mortality (46.7% vs 51.9%; p = 0.031). Albumin decreased mortality in Shock-2 patients compared to crystalloids (43.5% vs 49.9%; 12.6% relative risk reduction; p = 0.04). In patients defined by Shock-3 a similar benefit was observed for albumin with a 11.3% relative risk reduction (48.7% vs 54.9%; 11.3% relative risk reduction; p = 0.22). Conclusions The Sepsis-3 definition reduced the size of the population with shock and showed a similar effect size in the benefits of albumin. The Shock-3 criteria will markedly slow patients’ recruitment rates, in view of testing albumin in septic shock. Trial registration ClinicalTrials.gov, number NCT00707122. Registered on 30 June 2008.

【 授权许可】

Unknown