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Volume Replacement With Albumin in Severe Sepsis (ALBIOS)

This study has been completed.
Sponsor:
ClinicalTrials.gov Identifier:
NCT00707122
First Posted: June 30, 2008
Last Update Posted: November 10, 2015
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
Information provided by (Responsible Party):
Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico
  Purpose

BACKGROUND The association between mortality and hypoalbuminemia has been observed in several diseases. Nonetheless, the efficacy of albumin on survival in critically ill patients is controversial. Several meta-analyses have reported either negative, neutral, or beneficial effects of albumin administration. To clarify this controversy, a large multicenter prospective study has been performed, comparing the effects of 4% albumin vs. saline for volume replacement in critically ill patients. Although no difference in the overall mortality has been observed, a predefined subgroup analysis has shown a trend of longer survival in septic patients treated with albumin. As fluid replacement has been shown to be critical in sepsis, and based on both its primary (oncotic) and secondary properties (anti-inflammatory), it is conceivable that the use of albumin for volume replacement and for treating hypoalbuminemia may have a beneficial effects on survival of septic patients.

OBJECTIVES Primary objective: to verify whether volume replacement with albumin (treated group) and its maintenance within plasmatic physiologic range (equal or above 30 g/l) improves survival of patients with severe sepsis of septic shock, as compared to crystalloids (control group). Secondary objectives: to verify the differences in organ dysfunctions, hospital and intensive care unit (ICU) length of stay between the treated and control group.

METHODS About 1350 patients with severe sepsis or septic shock will be randomized to receive either albumin or crystalloids as fluid therapy. Volume replacement will be performed for both groups according to the early-goal directed therapy. Treated group will receive 60 gr albumin infusion after randomization, and 40-60 gr albumin daily infusion to maintain serum album level equal or above 30 g/l. Control group will receive crystalloids for the entire study; albumin administration will be allowed only when daily serum albumin level will be lower than 15 g/l. Patients will be treated until the 28th day after randomization or until ICU discharge, whichever comes first.

EXPECTED RESULTS Primary outcomes: absolute risk reduction of overall mortality of 7.5% at 28th day, with a further control at 90th day, following randomization. Secondary outcomes: reduction of number and severity of organ dysfunctions (as assessed by the Sequential Organ Failure Assessment score), reduction of ICU and hospital length of stay.


Condition Intervention Phase
Severe Sepsis Septic Shock Other: Albumin and Crystalloids Other: Crystalloids Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Efficacy of Albumin Administration for Volume Replacement in Patients With Severe Sepsis or Septic Shock - the ALBumin Italian Outcome Sepsis (ALBIOS) Study

Resource links provided by NLM:


Further study details as provided by Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico:

Primary Outcome Measures:
  • mortality rate at the 28th day after randomization, with a further control at 90th day. [ Time Frame: mortality at 28th and 90th day after randomization ]

Secondary Outcome Measures:
  • Number and severity of organ dysfunction (as recorded by the SOFA score) [ Time Frame: At 28th day after randomization and at ICU discharge ]
  • ICU length of stay [ Time Frame: ICU discharge ]
  • Hospital length of stay [ Time Frame: Hospital discharge ]

Enrollment: 1818
Study Start Date: July 2008
Study Completion Date: October 2013
Primary Completion Date: April 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
1, Albumin and Crystalloids
Treatment
Other: Albumin and Crystalloids

From day 2 to day 28 (or until ICU discharge, whichever comes first), fluid will be administered as follows:

1. treated group: albumin will be infused on a daily basis, aimed to maintain its serum concentration equal or above 30 g/l (8). In particular, after the daily determination of its serum level:

  1. if lower than 25 g/l, 300 ml of 20% of albumin solution (total amount of 60 gr) will be infused;
  2. if equal or higher than 25 g/l and below 30 g/l, 200 ml of 20% of albumin solution (total amount of 40 gr) will be infused;
  3. if higher than or equal to 30 g/l, no albumin will be infused. Albumin solutions will be infused over a period of 3 hours. Further infusion of crystalloids will be allowed, when necessary, according to the clinical judgment. No infusion of colloids, other than albumin, will be admitted.
2, Crystalloids
Control
Other: Crystalloids

Volume replacement will be performed in both the treated and the control group according to the "early-goal directed therapy".

control group: crystalloids infusion will be allowed whenever necessary on a clinical basis. Albumin administration will be restricted to emergency use, as clinically judged and documented according to the standard criteria of each participating unit. No other colloids will be allowed.


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  Eligibility

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients with severe sepsis or septic shock, if each one of the following criteria is satisfied:

    • Proved or suspected infection in at least one site:

      • lung
      • abdomen
      • genito-urinary tract
      • other (blood, skin and soft tissue, central nervous system, bones and joints, cardiac system, catheter-related infection, other)
    • Two or more of the following:

      • a core temperature ≥ 38° C o ≤ 36° C
      • a heart rate ≥ 90 beats/min
      • a respiratory rate ≥ 20 breaths/min or PaCO2 ≤ 32 mmHg or use of mechanical ventilation for an acute process
      • a white blood cell count ≥ 12000/ml or ≤ 4000/ml or immature neutrophils > 10%
    • Presence of at least a severe organ dysfunction, as measured by the modified Sequential Organ Failure Assessment (SOFA) score:

      • respiratory score > 1
      • hematologic score > 1
      • hepatic score > 1
      • cardiovascular score equal to 1, 3 or 4
      • renal score > 1

Exclusion Criteria:

  • Age below 18 years
  • Terminal state
  • Known adverse reaction to albumin administration
  • Severe sepsis or septic shock in patients after proved or suspected head injury, clinically active
  • Congestive heart failure (NYHA score III and IV)
  • Pathological conditions in which albumin administration is clinically indicated (hepatic cirrhosis with ascites, intestinal malabsorption syndrome, nephritic syndrome, burns)
  • More than 24 hours since inclusion criteria were met
  • Religious objection to the administration of human blood products
  • Inclusion in other experimental study
  Contacts and Locations
Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00707122


Locations
Italy
Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico; Via F. Sforza 35
Milano, Italy, 20135
Sponsors and Collaborators
Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico
Investigators
Principal Investigator: Luciano Gattinoni, MD Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche; Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico
Study Chair: Pietro Caironi, MD Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche; Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico
Study Chair: Antonio Pesenti, MD Dipartimento di Medicina Perioperatoria e Terapia Intensiva, Azienda Ospedaliera San Gerardo di Monza, Università degli Studi Milano-Bicocca
Study Chair: Roberto Fumagalli, MD Dipartimento di Medicina Perioperatoria e Terapia Intensiva, Azienda Ospedaliera San Gerardo di Monza, Università degli Studi Milano-Bicocca
Study Chair: Gianni Tognoni, MD Consorzio Mario Negri Sud, S. Maria Imbaro
Study Chair: Marilena Romero Consorzio Mario Negri Sud, S. Maria Imbaro
Study Chair: Roberto Latini, MD Istituto Di Ricerche Farmacologiche Mario Negri
Study Chair: Serge Masson Istituto Di Ricerche Farmacologiche Mario Negri
  More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico
ClinicalTrials.gov Identifier: NCT00707122     History of Changes
Other Study ID Numbers: ALBIOS
First Submitted: June 26, 2008
First Posted: June 30, 2008
Last Update Posted: November 10, 2015
Last Verified: November 2015

Keywords provided by Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico:
serum albumin, severe sepsis, septic shock, fluid therapy, hypoalbuminemia, critically ill

Additional relevant MeSH terms:
Sepsis
Toxemia
Shock
Shock, Septic
Infection
Systemic Inflammatory Response Syndrome
Inflammation
Pathologic Processes