title: Comparison of the effects of albumin and crystalloid on mortality in adult patients with severe sepsis and septic shock: a meta-analysis of randomized clinical trials.
abstract: BACKGROUND
  The aim of this study was to examine whether albumin reduced mortality when employed for the resuscitation of adult patients with severe sepsis and septic shock compared with crystalloid by meta-analysis.
  
  
  METHODS
  We searched for and gathered data from MEDLINE, Elsevier, Cochrane Central Register of Controlled Trials and Web of Science databases. Studies were eligible if they compared the effects of albumin versus crystalloid therapy on mortality in adult patients with severe sepsis and septic shock. Two reviewers extracted data independently. Disagreements were resolved by discussion with other two reviewers until a consensus was achieved. Data including mortality, sample size of the patients with severe sepsis, sample size of the patients with septic shock and resuscitation endpoints were extracted. Data were analyzed by the methods recommended by the Cochrane Collaboration Review Manager 4.2 software.
  
  
  RESULTS
  A total of 5,534 records were identified through the initial search. Five studies compared albumin with crystalloid. In total, 3,658 severe sepsis and 2,180 septic shock patients were included in the meta-analysis. The heterogeneity was determined to be non-significant (P = 0.86, I(2) = 0%). Compared with crystalloid, a trend toward reduced 90-day mortality was observed in severe sepsis patients resuscitated with albumin (odds ratio (OR) 0.88; 95% CI, 0.76 to 1.01; P = 0.08). However, the use of albumin for resuscitation significantly decreased 90-day mortality in septic shock patients (OR 0.81; 95% CI, 0.67 to 0.97; P = 0.03). Compared with saline, the use of albumin for resuscitation slightly improved outcome in severe sepsis patients (OR 0.81; 95% CI, 0.64 to 1.08; P = 0.09).
  
  
  CONCLUSIONS
  In this meta-analysis, a trend toward reduced 90-day mortality was observed in severe sepsis patients resuscitated with albumin compared with crystalloid and saline. Moreover, the 90-day mortality of patients with septic shock decreased significantly.
authors.affiliation: Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Rd, Nanjing, 210009, P.R. China. xujingyuanmail@163.com.
authors.forename: Jing-Yuan
authors.initials: JY
authors.lastname: Xu
authors.affiliation: Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Rd, Nanjing, 210009, P.R. China. chenqihong00@163.com.
authors.forename: Qi-Hong
authors.initials: QH
authors.lastname: Chen
authors.affiliation: Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Rd, Nanjing, 210009, P.R. China. xie820405@126.com.
authors.forename: Jian-Feng
authors.initials: JF
authors.lastname: Xie
authors.affiliation: Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Rd, Nanjing, 210009, P.R. China. panchun1982@gmail.com.
authors.forename: Chun
authors.initials: C
authors.lastname: Pan
authors.affiliation: Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Rd, Nanjing, 210009, P.R. China. liusongqiao@ymail.com.
authors.forename: Song-Qiao
authors.initials: SQ
authors.lastname: Liu
authors.affiliation: Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Rd, Nanjing, 210009, P.R. China. liweihuang2011@163.com.
authors.forename: Li-Wei
authors.initials: LW
authors.lastname: Huang
authors.affiliation: Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Rd, Nanjing, 210009, P.R. China. congshany2006@aliyun.com.
authors.forename: Cong-Shan
authors.initials: CS
authors.lastname: Yang
authors.affiliation: Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Rd, Nanjing, 210009, P.R. China. liulingdoctor@gmail.com.
authors.forename: Ling
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Rd, Nanjing, 210009, P.R. China. yz_huang@126.com.
authors.forename: Ying-Zi
authors.initials: YZ
authors.lastname: Huang
authors.affiliation: Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Rd, Nanjing, 210009, P.R. China. fmguo2003@139.com.
authors.forename: Feng-Mei
authors.initials: FM
authors.lastname: Guo
authors.affiliation: Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Rd, Nanjing, 210009, P.R. China. yiyiyang2004@163.com.
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Rd, Nanjing, 210009, P.R. China. haiboq2000@gmail.com.
authors.forename: Hai-Bo
authors.initials: HB
authors.lastname: Qiu
mesh_terms: D000328:Adult; D000418:Albumins / Q000008:administration & dosage*; D000077324:Crystalloid Solutions; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage*; D009026:Mortality / Q000639:trends; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000401:mortality; D012151:Resuscitation / Q000379:methods; D018805:Sepsis / Q000401:mortality / Q000628:therapy; D012772:Shock, Septic / Q000401:mortality* / Q000628:therapy*
chemical_list: D000418:Albumins; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions