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The following is a summary of “Net albumin leakage in patients in the ICU with suspected sepsis. A prospective analysis using mass balance calculations,” published in the March 2025 issue of Critical Care by Seldén et al. 

Albumin dynamics in septic shock are well studied, but guidance remains limited, and net albumin leakage (NAL), including lymphatic return, is unexplored in sepsis.  

Researchers conducted a retrospective study to evaluate NAL in 10 ICU individuals with suspected sepsis and explored its associations with fluid overload, glycocalyx shedding products, and cytokines.  

They assessed 10 individuals within 12 hours of ICU admission for suspected sepsis at Karolinska University Hospital Huddinge. Albumin, hematocrit, and hemoglobin levels were measured at 0, 1, 2, 4, 8, and 24 hours. The NAL was estimated using mass balance calculations, comparing proportional changes in albumin and hemoglobin concentrations over time. Adjustments were made for albumin and hemoglobin infusions and losses. A proportionally greater decrease or smaller increase in albumin compared to hemoglobin indicated NAL, reflecting net leakage from circulation to the interstitium minus lymphatic return.  

The results showed a net positive albumin leakage to the interstitium of 8 ± 10 grams over 24 hours (P = 0.029). The NAL had no correlation with glycocalyx shedding products or fluid overload but showed a weak correlation with interleukin-6 and interleukin-8 during the first 4 hours. Albumin infusions appeared to increase net leakage.  

Investigators concluded that ICU patients with suspected sepsis experienced net positive albumin leakage, weakly correlated with early pro-inflammatory cytokines, and that albumin infusions paradoxically increased the leakage. 

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-025-05323-9