Endothelium Protective Effect of 5% Human Albumin-Based Fluid Therapy in Perforation Peritonitis Patients Undergoing Emergency Laparotomy: A Randomized Controlled Trial.

INTRODUCTION

Preclinical and retrospective data indicated that albumin therapy may be associated with endothelial protection and lower net fluid balance in sepsis. However, endothelial protective effect of albumin has never been evaluated in a clinical trial. We therefore hypothesized that an infective, inflammatory condition like perforation peritonitis, which requires substantial fluid replacement, may benefit from albumin therapy.

METHODS

Adult patients undergoing emergent/urgent abdominal surgery for perforation peritonitis were randomized to either group A or group P receiving 5% human albumin or Plasma-Lyte fluid therapy, respectively. Serum endothelial glycocalyx degradation products (syndecan-1, heparan sulfate) and inflammatory biomarkers (TNF-a, interleukins [IL]-1b, IL-10, and IL-6) were measured at the baseline, 6 h, and 24 h postoperatively.

RESULTS

In this study, n = 50 patients were randomized, and complete outcome data for n = 48 patients were available. Median (interquartile range) values of syndecan-1, heparan sulfate, TNF-a, IL-1b, IL-6, and IL- 10 were statistically similar at all time points. Repeated measured two-way ANOVA reported a significant interaction in heparan sulfate (F [2, 88] = 3.60, P = 0.026), TNF-a (F [2, 88] = 3.75, P = 0.027), and IL-10 (F [2, 88] = 4.84, P = 0.02) between the time point of measurement and type of fluid therapy. Intraoperative vasopressor requirement was lower with albumin [P = 0.047].

CONCLUSIONS

Although 5% albumin-based fluid therapy failed to reduce syndecan-1 level, as compared to Plasma-Lyte, it possibly resulted in better perioperative hemodynamic stability and lesser fluid administration. This finding should be considered as 'hypothesis-generating' and need further validation.