ABC-SEPSIS trial for albumin in septic shock
Neither of two large randomized trials in the 2000s showed a benefit from albumin solutions as a resuscitation fluid for patients with septic shock.
Significant uncertainty remained, though, as we discussed further here:
Another randomized trial was therefore performed, dubbed ABC-SEPSIS.
ABC-SEPSIS Trial
The ABC-SEPSIS trial (Gray et al Crit Care Med 2024) was conceived as a feasibility study for a larger trial to definitively test albumin vs crystalloid in septic shock.
At 15 emergency departments in the U.K., authors enrolled 300 adults with sepsis and a National Early Warning Score 2 of ≥5 requiring IV fluids within one hour of randomization.
Patients in the intervention arm were randomized to receive either 5% albumin or crystalloid (not both) for the first 6 hours after randomization.
After 30 days of follow-up, 31 (21.1%) had died in the 5% albumin arm, compared with 22 (14.8%) in the crystalloid arm (adjusted odds ratio 1.50 with 95% confidence intervals 0.84-2.83).
Because of the nominally increased mortality in the albumin arm, authors concluded that “a definitive trial is likely to be deliverable, but … such a trial would be unlikely to demonstrate a significant benefit from using 5% [albumin] as a primary resuscitation fluid in sepsis.”
But this leaves room for future debate: what if patients had also received crystalloid with albumin? Why limit the intervention to only the first 6 hours? What if the intervention was only provided to patients with evidence of fluid responsiveness?
For more context and analysis of the ABC-SEPSIS trial in the larger question of albumin’s role in resuscitation in septic shock, please read our review.