Effect of fluid resuscitation with crystalloid combined with plasma on the prognosis of septic patients with hypoalbuminemia
Objective To evaluate the difference in efficacy of two fluid resuscitation regimens,crystalloid alone versus crystalloid combined with plasma infusion,on the prognosis of septic patients with hypoalbuminemia.Methods A retrospective study was conducted.Septic patients with hypoalbuminemia admitted to the department of critical care medicine of Dongtai People's Hospital from January 2017 to December 2022 were selected as study subjects.Patients were divided into single group(crystalloid alone)and combined group(crystalloid combined with plasma)according to the fluid resuscitation regimen at the time of admission.General information,as well as coagulation indices before resuscitation(on day 1)and day 3 of resuscitation were collected.The primary study endpoint was 28-day mortality.The single and combined groups were stratified according to albumin level at resuscitation(＜25 g/L,25-30 g/L,and＞30 g/L)to compare the differences in 28-day mortality among patients with different albumin levels.Kaplan-Meier survival curves of patients'28-day prognosis were plotted.Results A total of 164 septic patients with hypoalbuminemia were included,including 60 patients in the single group and 104 patients in the combined group.① There were no significantly differences in age,gender,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ),sequential organ failure assessment(SOFA),as well as pre-resuscitation platelet count(PLT),prothrombin time(PT),activated partial thromboplastin time(APTT),D-dimer,antithrombin-Ⅲ(AT-Ⅲ),international normalized ratio(INR),fibrin degradation product(FDP),serum lactic acid(Lac),and albumin level between the two groups,indicating comparability.② The levels of PT and AT-Ⅲ in the combined group improved significantly on day 3 compared to before resuscitation,and the level of AT-Ⅲ in the combined group improved more significantly on day 3 compared to the single group[(79.80±17.95)％vs.(66.67±18.69)％,P＜0.01].Lac and albumin levels improved significantly after resuscitation in both the single and combined groups,but there were no significantly differences in the degree of improvement between the two groups.③ There was no significantly difference in the 28-day mortality between the single group and the combined group[55.0％(33/60)vs.42.3％(44/104),P＞0.05].The 28-day mortality of patients with albumin＜25 g/L was significantly higher than that with albumin 25-30 g/L and＞30 g/L[63.1％(41/65)vs.36.2％(25/69),36.7％(11/30),both P＜0.05].④ Kaplan-Meier survival curve analysis showed that there was no significantly difference in 28-day cumulative survival rate between the single group and the combined group(Log-Rank:x-2.067,P=0.151).The median survival rate of albumin was 27.1 g/L[95％confidence interval(95％CI)was 24.203-29.997]in the single group and 28.7 g/L(95％CI was 26.065-31.335)in the combined group.Conclusions Fluid resuscitation with crystalloid combined with plasma improves exogenous coagulation dysfunction in septic patients with hypoalbuminemia,but does not improve 28-day mortality outcome.The higher the initial albumin level in septic patients,the lower the mortality.
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