Human albumin administration in critically ill patients: systematic review of randomised controlled trials - PubMed (original) (raw)

Meta-Analysis

Human albumin administration in critically ill patients: systematic review of randomised controlled trials

Cochrane Injuries Group Albumin Reviewers. BMJ. 1998.

Abstract

Objective: To quantify effect on mortality of administering human albumin or plasma protein fraction during management of critically ill patients.

Design: Systematic review of randomised controlled trials comparing administration of albumin or plasma protein fraction with no administration or with administration of crystalloid solution in critically ill patients with hypovolaemia, burns, or hypoalbuminaemia.

Subjects: 30 randomised controlled trials including 1419 randomised patients.

Main outcome measure: Mortality from all causes at end of follow up for each trial.

Results: For each patient category the risk of death in the albumin treated group was higher than in the comparison group. For hypovolaemia the relative risk of death after albumin administration was 1.46 (95% confidence interval 0.97 to 2.22), for burns the relative risk was 2.40 (1.11 to 5.19), and for hypoalbuminaemia it was 1.69 (1.07 to 2.67). Pooled relative risk of death with albumin administration was 1.68 (1.26 to 2.23). Pooled difference in the risk of death with albumin was 6% (95% confidence interval 3% to 9%) with a fixed effects model. These data suggest that for every 17 critically ill patients treated with albumin there is one additional death.

Conclusions: There is no evidence that albumin administration reduces mortality in critically ill patients with hypovolaemia, burns, or hypoalbuminaemia and a strong suggestion that it may increase mortality. These data suggest that use of human albumin in critically ill patients should be urgently reviewed and that it should not be used outside the context of rigorously conducted, randomised controlled trials.

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Figures

Figure 1

Fixed effects model of relative risks (95% confidence interval) of death associated with intervention (fluid resuscitation with albumin or plasma protein fraction) compared with control (no albumin or plasma protein fraction or resuscitation with a crystalloid solution) in critically ill patients

Figure 2

Funnel plot for the 24 trials in which deaths occurred and that were used in systematic review

Comment in

• ACP J Club. 1999 Jan-Feb;130(1):6
• Excess mortality after human albumin administration in critically ill patients. Clinical and pathophysiological evidence suggests albumin is harmful.
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• Why albumin may not work.
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• Consider validity, clinical relevance, and applicability of albumin for critically ill patients.
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• Albumin: don't confuse us with the facts. Rather than fulminating, seek to answer the questions raised.
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• Human albumin administration in critically ill patients. Evidence needs to be shown in paediatrics.
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• Human albumin administration in critically ill patients. Review did not provide recommendations for alternative treatment.
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• Human albumin administration in critically ill patients. Albumin has been used in meningococcal disease.
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• Human albumin administration in critically ill patients. More research into proper use of albumin is needed.
  Kaag M, Zoetmulder FA. Kaag M, et al. BMJ. 1998 Sep 26;317(7162):883. BMJ. 1998. PMID: 9786696 No abstract available.
• Human albumin administration in critically ill patients. Analysis is superficial and conclusions exaggerated.
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• Human albumin administration in critically ill patients. Paper failed to mention earlier review.
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• Human albumin administration in critically ill patients. I would not want an albumin transfusion.
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• Human albumin administration in critically ill patients. Modified editorial might have restrained media response.
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• Human albumin administration in critically ill patients. Some patients may benefit.
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