Efficacy and Safety of Early Post-ICU Admission Colloid Resuscitation with 5% Albumin Versus 4% Gelatin Following 30 mL/kg Crystalloid in Septic Shock Patients Upon General Surgical ICU Admission: A Retrospective Study

Abstract

Objective: To compare the efficacy and safety of early post-ICU admission colloid resuscitation with 5% albumin versus 4% gelatin after 30 ml/kg crystalloid solution in septic shock patients upon general surgical ICU admission at Thailand’s largest tertiary reference center. Materials and Methods: This retrospective study included 125 adults with septic shock admitted to the ICU (September 2017-July 2018). After 30 mL/kg crystalloid, patients received 20 mL/kg of either 4% gelatin (Group G) or 5% albumin (Group A) if fluid responsive. The main efficacy was time to vasopressor discontinuation, and the main safety outcome was the incidence of acute kidney injury (AKI) per KDIGO criteria, within 72 hours of ICU admission. Other safety endpoints included allergic reactions, the need for renal replacement therapy (RRT), and 90-day mortality. Results: Of 125 patients, 62 received gelatin and 63 albumin. Despite being older, having more severe baseline illness, higher proportion undergoing surgical drainage prior to ICU admission, and a greater incidence of intraabdominal infections, Group A achieved faster vasopressor discontinuation (48 vs. 60 h; p=0.049), required less hydrocortisone (p=0.01), had lower SOFA-II scores (p=0.03), and higher serum albumin (p=0.03). In patients with hypoalbuminemia (<2.5 g/dL) or anemia (<9 g/dL), Group G was associated with higher AKI and RRT rates (p<0.05). No allergic reactions occurred, and ICU stay, hospital stay, and 90-day mortality were not different. Conclusion: Early 4% gelatin was associated with slower shock reversal and higher AKI risk compared with 5% albumin in critically ill surgical patients, while hospital stay and 90-day mortality were not different.