A Pilot Study on Continuous Infusion of 4% Albumin in Critically Ill Patients: Impact on Nosocomial Infection via a Reduction Mechanism for Oxidized Substrates.

Abstract

Care-related infections affect up to 11% of ICU patients. Running therapeutic albumin is sometimes associated to less infection: whether a specific method of its infusion is of any interest to modulate innate defense is unknown. Our objectives were: 1) to test whether the method for albumin infusion is important to prevent care-related infections and 2) to analyze in vitro the antioxidative role of albumin on host defense proteins during shock (using vasostatin-I as an example).

DESIGN:

In a prospective, randomized, open-label trial, shock patients were allocated to receive either continuously 4% albumin or intermittently 20% albumin, as long as they were infused with norepinephrine. A translational study including in vivo and in vitro analyses of albumin-vasostatin-I interactions is reported.

SETTING:

A tertiary ICU caring for 1,000 patients per year.

PATIENTS:

Fifty shock patients with serum albumin less than 20 g/L.

INTERVENTIONS:

In vivo colonization and nosocomial infections were recorded and time-dependent changes in serum albumin, chromogranin A, and vasostatin-I concentrations as well. In vitro, we studied biochemical albumin-vasostatin-I relationship using biochemical methods.

MEASUREMENTS AND MAIN RESULTS:

Over 18 days, we recorded a decrease in colonization (four vs 12 episodes; p = 0.035) and nosocomial infection frequency (two vs 13 episodes; p = 0.002) in patients infused continuously 4% albumin versus controls. In vitro, albumin interacts with the disulfide loop vasostatin-I (residues 17-40) and continuous 4% albumin infusion restores its oxidative status required for antimicrobial activity.

CONCLUSIONS:

Continuous 4% albumin is effective in reducing care-related infections in shock patients by increasing the availability of antimicrobial vasostatin-I. This might guide future care of shock patients.

• Authors: Francis Schneider, Anne-Florence Dureau, Sophie Hellé, Cosette Betscha, Bernard Senger, Gérard Cremel, Fouzia Boulmedais, Jean-Marc Strub, Angelo Corti, Nicolas Meyer, Max Guillot, Pierre Schaaf, Marie-Hélène Metz-Boutigue
• Journal: Critical care explorations (Crit Care Explor) Vol. 1 Issue 9 Pg. e0044 (Sep 2019) ISSN: 2639-8028 [Electronic] United States
• PMID: 32166286 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.