(1488) Assessing the Use of Albumin in Addition to Loop Diuretics for Fluid Deresuscitation in Septic Shock

Introduction: In patients with septic shock, studies suggest a positive fluid balance increases mortality. Few studies have outlined the most effective de-resuscitative agents for these patients. Hypertonic (25%) albumin currently lacks data supporting its use for de-resuscitation in septic shock patients, but has shown promise in other critical care disease states. In this study, we assessed the utility of hypertonic albumin in addition to loop diuretics for fluid de-resuscitation. We hypothesized that the addition of 25% albumin to intravenous loop diuretics in intensive care patients with septic shock increases diuresis to a higher degree than loop diuretics alone.

Methods: This was a retrospective, single-center, cohort study conducted at a 433-bed tertiary community hospital that compared the degree of diuresis in septic shock patients de-resuscitated with either intravenous loop diuretics alone or in combination with hypertonic albumin. Patients were 18 years of age in the intensive care unit (ICU) with a diagnosis of septic shock and received loop diuretics with or without albumin. The primary outcome was urine output at 24, 48, and. 72 hours. Secondary outcomes included ICU length of stay, hospital length of stay, mortality, 30-day readmission, and total cost of de-resuscitation.

Results: 55 patients met the pre-specified inclusion criteria. The median (IQR) urine output (ml/kg) in the monotherapy group at 24, 48, and 72 hours was 37.8 (40.7), 74.0 (64.9), and 106.6 (59.9) respectively. The median (IQR) urine output (ml/kg) in the combination therapy group was 32.8 (24.1), 65.8 (40.7), and 104.6 (59.1) respectively. These results did not reach statistical significance (p=0.162, p=0.348, and p=0.375 respectively). ICU length of stay and cost favored the monotherapy group (p=0.037 and p< 0.001 respectively). Hospital length of stay, mortality, and 30-day readmission were not significantly different between the groups.

Conclusions: This study demonstrated no improvement in urine output in septic shock patients receiving loop diuretics alone versus in combination with albumin. Larger randomized controlled trials with protocolized trial design are needed to assess the benefit of albumin for diuresis in septic shock.