Background Some physicians co-administer albumin with loop diuretics to overcome diuretic resistance in critically ill hypoalbuminemia patients, though previous studies have reported conflicting results on this matter. Objective The effects of adding albumin to furosemide to enhance its efficacy in critically ill hypoalbuminemia patients are evaluated. Methods This was a non-blinded randomized trial. 49 adult critically ill patients with hypoalbuminemia and generalized edema who received randomly furosemide and furosemide/albumin complex were enrolled. The patients’ urine was collected at intervals of 2, 4, 6 and 8 h after initiation of the furosemide treatment, and the urine output and urinary excretion of furosemide and sodium were measured. The urinary excretion of furosemide was considered an indicator of drug efficacy. Results The amount of sodium and furosemide excreted in urine showed no significant differences between the two groups; however, the mean of the urinary excretion of furosemide in the first 2 h after drug infusion was significantly higher ( p = 0.03) in the furosemide/albumin group. No significant correlation between APACHE II scores and serum albumin levels and the urinary excretion of furosemide was seen. Conclusion The results indicated that there is not statistically significant differences between groups with furosemide alone and combined with albumin in urinary furosemide excretion. It seems that adding albumin for furosemide pharmacotherapy regime is not recommended as an intervention to increase furosemide efficacy in critically ill hypoalbuminemia patients. Trial registration IRCT with the registration number IRCT201412132582N12 in 23 February 2015; https://en.irct.ir/trial/2356 Graphical abstract

中文翻译：

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呋塞米-白蛋白与呋塞米在重症监护病房重症低白蛋白血症患者中的疗效比较：一项前瞻性随机临床试验

背景 一些医生联合使用白蛋白和袢利尿剂来克服危重低蛋白血症患者的利尿剂抵抗，尽管之前的研究报告了关于这个问题的相互矛盾的结果。目的评价呋塞米加白蛋白以提高其对重症低白蛋白血症患者的疗效。方法 这是一项非盲随机试验。纳入随机接受呋塞米和呋塞米/白蛋白复合物治疗的 49 名患有低白蛋白血症和全身性水肿的成年危重患者。在开始呋塞米治疗后每隔2、4、6和8小时收集患者的尿液，并测量尿量和尿中呋塞米和钠的排泄量。呋塞米的尿排泄量被认为是药物疗效的指标。结果两组尿钠和呋塞米的排泄量无显着差异；然而，在呋塞米/白蛋白组中，在药物输注后的前 2 小时内，呋塞米尿排泄的平均值显着更高（p = 0.03）。未观察到 APACHE II 评分与血清白蛋白水平和呋塞米尿排泄量之间存在显着相关性。结论 结果表明，呋塞米单用组与白蛋白联合应用组间尿呋塞米排泄量差异无统计学意义。似乎不推荐在呋塞米药物治疗方案中添加白蛋白作为一种干预措施，以提高重症低白蛋白血症患者的呋塞米疗效。2015年2月23日注册号IRCT201412132582N12试用注册IRCT；https://en.irct.ir/trial/2356 图形摘要