A Visual Protocol Integrating Dynamic Albumin, Prealbumin, and Transferrin Trajectories into Fluid and Nutritional Reassessment in Sepsis

This study developed a visual management approach for early fluid resuscitation in sepsis based on dynamic stratification of albumin, prealbumin, and transferrin. The retrospective analysis included 100 patients after propensity score matching. Measurements of the three proteins at T0, T6, T24, and T72 were considered together with fluid exposure, fluid responsiveness, and tissue perfusion indicators to derive a composite score and dynamic phenotypes; these results were then used to standardize reassessment, fluid management, and nutritional evaluation. Compared with conventional management, visual management showed numerically lower additional crystalloid administration during 3-6 h and total intravenous input during 0-24 h (median difference -6.70 mL/kg, 95% confidence interval -18.20 to 2.30; adjusted p = 0.091), as well as more frequent fluid-responsiveness assessments and an earlier first assessment, although none of these comparisons remained statistically significant after multiplicity adjustment. The prealbumin group-by-time interaction did not remain statistically significant after adjustment for multiplicity, and the composite-score findings were not interpreted due to unresolved scoring discrepancies. The visual management group had higher lactate clearance at 24 h in the exploratory 95-comparison Bonferroni sensitivity analysis (adjusted p = 0.040), whereas net fluid-balance differences at 24 h and 72 h did not remain statistically significant. Time to the resuscitation target was not significantly different in the 24 h censored Cox analysis (hazard ratio 1.509, 95% confidence interval 0.948-2.403; Bonferroni-adjusted p = 0.166), and no statistically significant differences were identified in organ-support requirements or mortality. This approach may offer a standardized framework for fluid reassessment and nursing decisions after initial resuscitation, although its clinical value requires confirmation in prospective, multicenter studies.