A Pilot Study on Continuous Infusion of 4% Albumin in Critically Ill Patients: Impact on Nosocomial Infection via a Reduction Mechanism for Oxidized Substrates. (September 2019)

• Record Type: Journal Article
• Authors: Schneider, Francis; Dureau, Anne-Florence; Hellé, Sophie; Betscha, Cosette; Senger, Bernard; Cremel, Gérard; Boulmedais, Fouzia; Strub, Jean-Marc; Corti, Angelo; Meyer, Nicolas; Guillot, Max; Schaaf, Pierre; Metz-Boutigue, Marie-Hélène
• Is Part Of: Critical care explorations. Volume 1:Number 9(2019)
• Publication Date: 2019-09
• Subjects: antimicrobial peptides -- chromogranin A -- critical care -- nosocomial infections -- protein-protein interaction -- therapeutic albumin
• DOI: 10.1097/CCE.0000000000000044
• Languages: English
• ISSNs: 2639-8028

Abstract

Abstract : Objective: Care-related infections affect up to 11% of ICU patients. Running therapeutic albumin is sometimes associated to less infection: whether a specific method of its infusion is of any interest to modulate innate defense is unknown. Our objectives were: 1) to test whether the method for albumin infusion is important to prevent care-related infections and 2) to analyze in vitro the antioxidative role of albumin on host defense proteins during shock (using vasostatin-I as an example). Design: In a prospective, randomized, open-label trial, shock patients were allocated to receive either continuously 4% albumin or intermittently 20% albumin, as long as they were infused with norepinephrine. A translational study including in vivo and in vitro analyses of albumin-vasostatin-I interactions is reported. Setting: A tertiary ICU caring for 1, 000 patients per year. Patients: Fifty shock patients with serum albumin less than 20 g/L. Interventions: In vivo colonization and nosocomial infections were recorded and time-dependent changes in serum albumin, chromogranin A, and vasostatin-I concentrations as well. In vitro, we studied biochemical albumin-vasostatin-I relationship using biochemical methods. Measurements and Main Results: Over 18 days, we recorded a decrease in colonization (four vs 12 episodes; p = 0.035) and nosocomial infection frequency (two vs 13 episodes; p = 0.002) in patients infused continuously 4% albumin versus controls. In vitro, albumin interacts with the disulfide loop vasostatin-I (residues 17–40) and continuous 4% albumin infusion restores its oxidative status required for antimicrobial activity. Conclusions: Continuous 4% albumin is effective in reducing care-related infections in shock patients by increasing the availability of antimicrobial vasostatin-I. This might guide future care of shock patients. Abstract : Supplemental Digital Content is available in the text.