title: Human albumin solution for resuscitation and volume expansion in critically ill patients. The Albumin Reviewers.
abstract: BACKGROUND
  Human albumin solutions are used in a range of medical and surgical problems. Licensed indications are the emergency treatment of shock and other conditions where restoration of blood volume is urgent, burns, and hypoproteinaemia. Human albumin solutions are more expensive than other colloids and crystalloids.
  
  
  OBJECTIVE
  To quantify the effect on mortality of human albumin and plasma protein fraction (PPF) administration in the management of critically ill patients.
  
  
  METHODS
  We searched the Cochrane Injuries Group trials register, Cochrane Controlled Trials Register, Medline, Embase and BIDS Index to Scientific and Technical Proceedings. Reference lists of trials and review articles were checked, and authors of identified trials were contacted. The search was last updated in November 1999.
  
  
  METHODS
  Randomised controlled trials comparing albumin/PPF with no albumin/PPF, or with a crystalloid solution, in critically ill patients with hypovolaemia, burns or hypoalbuminaemia.
  
  
  METHODS
  We collected data on the participants, albumin solution used, mortality at the end of follow up, and quality of allocation concealment. Analysis was stratified according to patient type. We assessed publication bias using the regression test for funnel plot asymmetry.
  
  
  RESULTS
  We found 30 trials meeting the inclusion criteria and reporting death as an outcome. There were 156 deaths among 1419 trial participants. 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 following 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 the relative risk was 1.69 (1.07 to 2.67). The pooled relative risk of death with albumin administration was 1.68 (1.26 to 2.23). Overall, the risk of death in patients receiving albumin was 14% compared to 8% in the control groups, an increase in the risk of death of 6% (3% to 9%). 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 the risk of death in critically ill patients with hypovolaemia, burns or hypoalbuminaemia, and a strong suggestion that it may increase the risk of death. These data suggest that the use of human albumin in critically ill patients should be urgently reviewed and that it should not be used outside the context of a rigorously conducted randomised controlled trial.
authors.affiliation: Department of Epidemiology, Institute of Child Health, 30 Guilford Street, London, UK, WC1N 1EH. Ian.roberts@ich.ucl.ac.uk
authors.forename: F
authors.initials: F
authors.lastname: Bunn
authors.forename: C
authors.initials: C
authors.lastname: Lefebvre
authors.forename: A
authors.initials: A
authors.lastname: Li Wan Po
authors.forename: L
authors.initials: L
authors.lastname: Li
authors.forename: I
authors.initials: I
authors.lastname: Roberts
authors.forename: G
authors.initials: G
authors.lastname: Schierhout
mesh_terms: D001798:Blood Proteins / Q000627:therapeutic use*; D016638:Critical Illness / Q000628:therapy*; D005440:Fluid Therapy; D006801:Humans; D010952:Plasma Substitutes / Q000627:therapeutic use*; D012709:Serum Albumin / Q000627:therapeutic use*; D000075462:Serum Albumin, Human; D012712:Serum Globulins
chemical_list: D001798:Blood Proteins; D010952:Plasma Substitutes; D012709:Serum Albumin; D012712:Serum Globulins; C008930:plasma protein fraction; D000075462:Serum Albumin, Human