Comparing 20% Albumin to Normal Saline for Volume Replacement in Critically Ill Patients with Sepsis/Septic Shock

Background: Albumin (Alb) exerts oncotic and pleiotropic actions that could be advantageous in cases with sepsis or septic shock (SS), yet its superiority as opposed to crystalloid solutions remains unresolved.
Objective: Compare 20% Alb versus normal saline for intravascular volume resuscitation in critically ill adults with sepsis or SS.
Patients and Methods: Single-center randomized controlled trial at Benha University intensive care unit (January–July 2024). Adults with sepsis ± shock were randomized 1:1 to 20% Alb plus crystalloids (target serum Alb ≥30 g/L to day 28 or intensive care unit discharge) versus crystalloids alone. Eighty cases were randomized (Alb n=40; crystalloid n=40). Primary outcome was 28-day all-cause mortality. Key secondary outcomes included 90-day mortality; SAPS II; SOFA total and subscores; organ failures; vasopressor duration; mechanical ventilation (MV) days; renal replacement therapy; and ICU and hospital length of stay.
Results: SAPS II was diminished with Alb (46.7 ± 8.0 vs 50.4 ± 6.7; p=0.044). Measures exhibited comparability for heart rate, MAP, CVP, ScvO₂, total SOFA, organ dysfunction count, shock incidence, ventilation, urine output, lactate, and lengths of stay (all p>0.05). SOFA coagulation subscore was elevated with Alb (0.70 ± 0.08 vs 0.53 ± 0.07; p=0.046). Mortality exhibited comparability at 28 days (32.5% vs 35.0%; p=0.28) and 90 days (25.0% vs 30.0%; p=0.62). Prolonged vasopressor exposure was associated with 90-day death (log-rank χ²=3.88; p=0.049).
Conclusion: Administration of 20% Alb did not reduce 28- or 90-day mortality versus crystalloids; most clinical outcomes exhibited comparability.