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Abstract

In this single-center pilot trial of 60 ICU patients, early administration of 5% albumin in addition to crystalloid did not significantly improve Systemic Inflammatory Response Syndrome (SIRS) remission at Day 3 nor reduce 60-day mortality.1 However, a statistically significant reduction in sepsis was observed in the albumin group compared with crystalloid alone (10% vs. 36.7%, P = 0.01). Although the study concludes that albumin did not improve prognosis, we believe the observed difference in sepsis merits further consideration.

Infection and persistent organ failure are well-established determinants of mortality in acute pancreatitis, particularly in the later phases of disease progression. Petrov et al. demonstrated that infected pancreatic necrosis and organ failure are primary drivers of mortality in severe acute pancreatitis (SAP), underscoring the clinical importance of infection-related outcomes.2 Thus, even in the absence of demonstrated mortality benefit, a reduction in sepsis may represent a clinically meaningful endpoint.

Albumin possesses anti-inflammatory, antioxidant, and endothelial-stabilizing properties that may modulate host response during systemic inflammation.3 In sepsis populations, the ALBIOS trial found no overall mortality benefit with albumin replacement; however, subgroup analyses suggested potential advantages in patients with septic shock, including improved hemodynamics and decreased use of vasopressors.4 Furthermore, the 2021 Surviving Sepsis Campaign suggests the use of albumin in patients requiring substantial crystalloid resuscitation.5 Given the pathophysiologic parallels between SAP and sepsis, the reduction in sepsis observed in this trial is biologically plausible.

Importantly, as a pilot study, this trial was not powered to detect differences in mortality. The relatively low mortality rate and strict exclusion criteria may have limited the ability to identify benefits in higher-risk patients. Future multicenter studies, particularly those focused on infection-related outcomes and stratified by disease severity, may better clarify whether albumin confers benefit in select SAP populations.

In conclusion, while albumin did not improve SIRS remission or mortality in this study, the significant reduction in sepsis highlights a potentially meaningful therapeutic signal. We believe this finding warrants further investigation and may inform the design of future trials evaluating fluid strategies in severe acute pancreatitis.

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