title: Effect of baseline serum albumin concentration on outcome of resuscitation with albumin or saline in patients in intensive care units: analysis of data from the saline versus albumin fluid evaluation (SAFE) study.
abstract: OBJECTIVE
  To determine whether outcomes of resuscitation with albumin or saline in the intensive care unit depend on patients' baseline serum albumin concentration.
  
  
  METHODS
  Analysis of data from a double blind, randomised controlled trial.
  
  
  METHODS
  Intensive care units of 16 hospitals in Australia and New Zealand.
  
  
  METHODS
  6045 participants in the saline versus albumin fluid evaluation (SAFE) study.
  
  
  METHODS
  Fluid resuscitation with 4% albumin or saline in patients with a baseline serum albumin concentration of 25 g/l or less or more than 25 g/l.
  
  
  METHODS
  Primary outcome was all cause mortality at 28 days. Secondary outcomes were length of stay in the intensive care unit, length of stay in hospital, duration of renal replacement therapy, and duration of mechanical ventilation.
  
  
  RESULTS
  The odds ratios for death for albumin compared with saline for patients with a baseline serum albumin concentration of 25 g/l or less and more than 25 g/l were 0.87 and 1.09, respectively (ratio of odds ratios 0.80, 95% confidence interval 0.63 to 1.02); P=0.08 for heterogeneity. No significant interaction was found between baseline serum albumin concentration as a continuous variable and the effect of albumin and saline on mortality. No consistent interaction was found between baseline serum albumin concentration and treatment effects on length of stay in the intensive care unit, length of hospital stay, duration of renal replacement therapy, or duration of mechanical ventilation.
  
  
  CONCLUSIONS
  The outcomes of resuscitation with albumin and saline are similar irrespective of patients' baseline serum albumin concentration.
  
  
  BACKGROUND
  ISRCTN76588266.
authors.affiliation: Australian and New Zealand Intensive Care Society Clinical Trials Group, Carlton, Vic 3053, Australia. sfinfer@george.org.au
authors.forename: Simon
authors.initials: S
authors.lastname: Finfer
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.forename: Suzanne
authors.initials: S
authors.lastname: McEvoy
authors.forename: Sing Kai
authors.initials: SK
authors.lastname: Lo
authors.forename: John
authors.initials: J
authors.lastname: Myburgh
authors.forename: Bruce
authors.initials: B
authors.lastname: Neal
authors.forename: Robyn
authors.initials: R
authors.lastname: Norton
mesh_terms: D000418:Albumins / Q000008:administration & dosage*; D002423:Cause of Death; D003422:Critical Care / Q000379:methods*; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012151:Resuscitation / Q000379:methods*; D012709:Serum Albumin / Q000378:metabolism*; D012965:Sodium Chloride / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000418:Albumins; D012709:Serum Albumin; D012965:Sodium Chloride