Human albumin administration in critically ill patients: systematic review of randomised controlled trials.
OBJECTIVE
To quantify effect on mortality of administering human albumin or plasma protein fraction during management of critically ill patients.


METHODS
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.


METHODS
30 randomised controlled trials including 1419 randomised patients.


METHODS
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.
Cochrane Injuries Group, Department of Epidemiology and Public Health, Institute of Child Health, London WC1N 1EH.
D000418:Albumins / Q000009:adverse effects*; D001798:Blood Proteins / Q000009:adverse effects; D002056:Burns / Q000188:drug therapy / Q000401:mortality; D003102:Colloids / Q000009:adverse effects; D016638:Critical Illness / Q000401:mortality*; D003460:Crystallization; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012709:Serum Albumin / Q000172:deficiency; D012769:Shock / Q000188:drug therapy / Q000401:mortality
D000418:Albumins; D001798:Blood Proteins; D003102:Colloids; D012709:Serum Albumin