Background:Sepsis affects millions of people and imposes a substantial economic and social burden worldwide. However, the role of human albumin in the management of septic patients remains unclear.Methods:EMBASE, PubMed, and Cochrane Library databases were searched. Randomized controlled trials regarding the use of human albumin in septic patients were eligible. The overall mortality and the intensive care unit (ICU), in-hospital/28-day, and 90-day mortality were pooled, respectively. Subgroup analyses were performed according to target population, type and dose of human albumin, and type of control group. Risk ratios (RRs) was calculated.Results:Twenty-four randomized controlled trials were finally included. Meta-analysis showed that human albumin cannot decrease the overall (RR = 1.02, P = .56), ICU (RR = 1.06, P = .65), in-hospital/28-day (RR = 1.01, P = .68), and 90-day (RR = 1.01, P = .65) mortality of total patients. Subgroup analyses showed that human albumin both cannot significantly decrease the overall, ICU, in-hospital/28-day, and 90-day mortality of sepsis and septic patients. Additionally, 20% human albumin (RR = 0.89, P = .03) and high daily dose of human albumin (RR = 0.90, P = .03) might benefit for the survival of patients with septic shock.Conclusions:Based on the current evidence, the general use of human albumin to improve the survival of septic patients cannot be recommended.

2017-03-01·Indian Journal of Hematology and Blood Transfusion4区 · 医学

Therapeutic Plasma Exchange in Patients with Neurologic Disorders: Review of 63 Cases

4区 · 医学

Article

作者: Akdeniz, Aydan ; Tombak, Anil ; Uçar, Mehmet Ali ; Tiftik, Eyup Naci ; Sungur, Mehmet Ali ; Yilmaz, Arda ; Kaleagası, Hakan

Therapeutic plasma exchange (TPE) is a procedure that reduces circulating autoantibodies of the patients. TPE is commonly used in neurological disorders where autoimmunity plays a major role. We report our experience with regard to the indications, adverse events and outcomes of plasma exchange in neurological disorders. Sixty-three patients were included to this retrospective study. Median age was 48 years (range 1-85), there was a predominance of males. Neurological indications included Guillain-Barrè syndrome (n = 22), myasthenia gravis (n = 21), chronic inflammatory demyelinating polyneuropathy (n = 7), polymyositis (n = 3), multifocal motor neuropathy (n = 2), acute disseminated encephalomyelitis (n = 2), neuromyelitis optica (n = 2), multiple sclerosis (n = 2), limbic encephalitis (n = 1) and transverse myelitis (n = 1). TPE was frontline therapy in 57 % of the patients (n = 36). Total number of TPE sessions was 517; median number of sessions per patient was 8 (range 1-66). TPE was done through a central venous access in 97 % and through a peripheral venous access in 3 % of the patients. Human albumin was used as replacement fluid in 49 %, hydroxyethyl starch (HES) in 49 % and fresh frozen plasma in 2 % of the cases. Adverse reactions were recorded in 60 % of the patients. Total ratio of complications in 517 TPE procedures was 10.8 % and these were mild and manageable such as allergic reactions and hypotension. Overall response rate was 81 %. Interestingly, complication and response rates were similar in both HES and human albumin groups. We conclude that TPE is an effective treatment in neurologic diseases in which autoimmunity plays an important role in the pathogenesis and HES can be used instead of albumin as replacement fluid in these disorders, since it is cost-effective, has similar efficacy and complication rates.

2015-12-01·Critical Care

Albumin infusion for the critically ill – is it beneficial and, if so, why and how?

作者: Das, Undurti N

Human albumin is used for volume expansion and resuscitation and to correct hypoalbuminemia [1]. Hypoalbuminemia is frequent in sepsis and is a strong predictor of mortality and morbidity [2]. Fluid volume expansion and resuscitation of the critically ill with albumin has been recommended by the UK National Institute for Health and Care Excellence and the Surviving Sepsis Campaign (grade 2C), although the evidence for these recommendations is not strong [1,3-8] and use of albumin to correct or improve hypoalbuminemia remains controversial [7,8] despite the fact that albumin is safe to use for the critically ill [8]. Albumin mobilizes polyunsaturated fatty acids (PUFAs) from the liver and other tissues, and thus enhances the formation of cytoprotective bioactive lipids – lipoxins, resolvins and protectins – that, in turn, suppress production of proinflammatory prostaglandins, free radicals and cytokines. The beneficial actions of albumin thus depend on its ability to mobilize PUFAs and the formation of adequate amounts of lipoxins, resolvins and protectins. For those who have hepatic and tissue deficiency of PUFAs, albumin fails to mobilize PUFAs and formation of lipoxins, resolvins and protectins will be inadequate, which may explain failure of the beneficial actions of albumin in the critically ill.

100 项与 Human Albumin(University of California) 相关的药物交易

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