Sepsis Resüsitasyonunda %25 Albüminin Erken Kullanımı Kötüleşen Böbrek Sonuçlarıyla İlişkili Değildir: MIMIC-IV Veritabanına Dayalı, Eğilim Skoruyla Eşleştirilmiş Retrospektif Kohort Çalışması

Abstract

Amaç: Sepsis resüsitasyonunda hiperonkotik (%25) albümin kullanımı, özellikle önceden böbrek yetmezliği olan hastalarda nefrotoksisite kaygıları nedeniyle tartışmalı olmaya devam etmektedir. Bu çalışmada, kristaloidlere ek olarak %25 albüminin erken uygulanmasının, yalnızca kristaloid uygulamasına kıyasla akut böbrek hasarı riskini artırıp artırmadığı veya kısa dönem hemodinamik sonuçları kötüleştirip kötüleştirmediği incelenmiştir. Gereç ve Yöntem: Geniş, kamuya açık bir yoğun bakım veritabanı kullanılarak retrospektif bir kohort çalışması yürütülmüştür. Yoğun bakıma kabulün ilk 24 saati içinde yalnızca kristaloid ya da kristaloidlere ek olarak %25 albümin alan sepsisli erişkin hastalar tanımlanmış; %5 albümin alan hastalar çalışma dışı bırakılmıştır. Demografik özellikler, laboratuvar değerleri, organ disfonksiyonu alt skorları ve komorbiditeler kullanılarak 1:1 eğilim skoru eşleştirmesi uygulanmıştır. Birincil sonlanım, standart konsensüs ölçütlerine göre tanımlanan akut böbrek hasarıydı. İkincil sonlanımlar renal replasman tedavisi, yoğun bakımda kalış süresi ve vazopresörsüz günlerdi. Bulgular: 15.882 hasta arasında 587 eşleştirilmiş çift analiz edilmiştir. Akut böbrek hasarı insidansı gruplar arasında benzerdi (albümin %60,3'e karşı kontrol %56,2; p = 0,174); renal replasman tedavisi gereksinimi de benzerdi (%23,9'a karşı %27,8; p = 0,142). Yoğun bakımda kalış süresi ve vazopresörsüz günler farklılık göstermedi. Albümin grubunda daha yüksek laktat düzeyleri ile daha belirgin hepatik ve koagülasyon disfonksiyonu bulunmasına rağmen, böbrek alt skorları ve komorbiditeler benzerdi. Sonuç: Kristaloidlerle birlikte %25 albüminin erken uygulanması, daha kötü kısa dönem böbrek veya hemodinamik sonuçlarla ilişkili bulunmamıştır. Bu bulgular klinik eşdeğerliği desteklemekte ve seçilmiş hastalarda %25 albüminin temkinli kullanımının ek bir böbrek riski getirmediğini düşündürmektedir.

Keywords

• albümin
• akut böbrek hasarı
• sepsis
• sıvı resüsitasyonu
• eğilim skoru eşleştirmesi
• yoğun bakım

Supporting Institution

Yoktur — bu araştırma; kamu, ticari veya kâr amacı gütmeyen sektörlerdeki herhangi bir finansman kuruluşundan özel bir hibe veya finansal destek almamıştır.

Ethical Statement

Bu çalışma, tamamen kimliksizleştirilmiş verilerden oluşan, kamuya açık bir veri kaynağı olan MIMIC-IV veritabanının ikincil bir analizidir. Veritabanının oluşturulması, Massachusetts Institute of Technology ve Beth Israel Deaconess Medical Center kurumsal değerlendirme kurulları tarafından bilgilendirilmiş onam muafiyetiyle onaylanmıştır. Bu ikincil analiz için ek bir etik kurul onayı gerekmemiş olup çalışma Helsinki Bildirgesi'ne uygun olarak yürütülmüştür.

Thanks

Yoktur. Bu makalenin hazırlanmasına yazar dışında katkıda bulunan kişi yoktur.

Early Use of 25% Albumin in Sepsis Resuscitation Is Not Associated with Worsened Renal Outcomes: A Propensity-Matched Retrospective Cohort Study of MIMIC-IV

Abstract

Objective: The use of hyperoncotic (25%) albumin in sepsis resuscitation remains controversial because of concerns about nephrotoxicity, particularly in patients with pre-existing renal impairment. This study examined whether early administration of 25% albumin in addition to crystalloids increases the risk of acute kidney injury or worsens short-term hemodynamic outcomes compared with crystalloids alone. Materials and Methods: A retrospective cohort study was performed using a large, publicly available intensive care database. Adult patients with sepsis who received crystalloids alone or crystalloids plus 25% albumin within the first 24 hours of intensive care admission were identified; patients receiving 5% albumin were excluded. Propensity score matching (1:1) was applied using demographics, laboratory values, organ-dysfunction sub-scores, and comorbidities. The primary outcome was acute kidney injury, defined by standardized consensus criteria. Secondary outcomes were renal replacement therapy, intensive care length of stay, and vasopressor-free days. Results: Among 15,882 patients, 587 matched pairs were analyzed. The incidence of acute kidney injury was similar between groups (albumin, 60.3% versus control, 56.2%; p = 0.174), as was the need for renal replacement therapy (23.9% versus 27.8%; p = 0.142). Intensive care length of stay and vasopressor-free days did not differ. Despite higher lactate levels and greater hepatic and coagulation dysfunction in the albumin group, renal sub-scores and comorbidities were comparable. Conclusion: Early administration of 25% albumin with crystalloids was not associated with worse short-term renal or hemodynamic outcomes. These findings support clinical equipoise and suggest that cautious use of 25% albumin in selected patients confers no additional renal risk.

Keywords

• Albumin
• Acute kiney injury
• Sepsis
• Fluid resuscitation
• Propensity score matching
• Critical care

Supporting Institution

None — this research received no specific grant or financial support from any funding agency in the public, commercial, or not-for-profit sectors.

Ethical Statement

This study was a secondary analysis of the MIMIC-IV database, a publicly available repository of fully de-identified data. Establishment of the database was approved by the institutional review boards of the Massachusetts Institute of Technology and Beth Israel Deaconess Medical Center, with a waiver of informed consent. No additional ethics committee approval was required for this secondary analysis, which was conducted in accordance with the Declaration of Helsinki.

Thanks

None. No individuals other than the author contributed to the preparation of this manuscript.

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