CRD summary

This review assessed whether albumin confers significant clinical benefit in acute illness compared with other fluid regimens. The authors concluded that albumin does confer benefits in a wide array of clinical settings. The authors' overall conclusion appears reliable, but the lack of an assessment of study quality and the limited reporting of individual studies make it difficult to assess the evidence presented.

Authors' objectives

To assess whether albumin confers significant clinical benefit in acute illness compared with other fluid regimens.

Searching

MEDLINE, EMBASE, the Cochrane Controlled Trials Register and the Cochrane Medical Editors Trial Amnesty of unpublished clinical trials were searched. No language restrictions were applied. The authors also handsearched general medical journals and Index Medicus, along with reference lists of completed reviews and protocols in the Cochrane Database of Systematic Reviews, other meta-analyses, review articles and reports of studies involving albumin. The authors of published albumin trials and the medical directors of albumin suppliers were contacted for additional relevant studies.

Study selection

Assessment of study quality

The authors did not state that they assessed validity.

Data extraction

Two reviewers independently extracted the data, with any disagreements resolved through discussion. Data on the clinical setting, fluid regimen and results were extracted.

Methods of synthesis

Results of the review

Seventy-nine RCTs with a total of 4,755 participants were included in the review.

In 14 of the 79 included trials there were potential confounding factors, such as the administration of concomitant albumin to all groups, or significantly higher baseline serum albumin levels in the control groups. The presence of these factors might have reduced the true treatment effects.

In 58 trials there was some form of clinical benefit in the albumin group compared with the control group, in 20 trials there was no significant difference between groups, and in one trial there was a negative effect in the albumin group compared with the control group.

Cardiac surgery (31 trials, 1,559 participants): albumin administration resulted in lower fluid requirements, higher colloid oncotic pressure, reduced pulmonary oedema with respiratory impairment and greater haemodilution compared with crystalloids; albumin reduced post-operative bleeding compared with hydroxyethylstarch.

Non-cardiac surgery (17 trials, 999 participants): albumin administration resulted in lower fluid requirements and reduced pulmonary and intestinal oedema compared with crystalloids.

Hypoalbuminaemia (9 trials, 536 participants): higher doses of albumin administration resulted in reduced morbidity.

Ascites (10 trials, 942 participants): albumin administration resulted in reduced haemodynamic derangements, morbidity and length of stay, and improved survival after spontaneous bacterial peritonitis.

Sepsis (4 trials, 104 participants): albumin administration resulted in reduced pulmonary oedema and pulmonary dysfunction compared with crystalloids; hydroxyethylstarch induced abnormalities of haemostasis.

Burns (4 trials, 197 participants): albumin administration resulted in decreased complications compared with crystalloids.

Brain injury (4 trials, 418 participants): albumin administration resulted in reduced mortality, disability and neurological deficits.

Authors' conclusions

Albumin confers benefits in a wide array of clinical settings. Further trials to delineate optimal fluid regimens in particular indications, such as hypoalbuminaemia and burns, are warranted.

CRD commentary

The review question was clear in terms of the study design, participants and interventions of interest. The search strategy was comprehensive, reducing the potential for publication bias. The data extraction was performed in duplicate, thus reducing the potential for error or reviewer bias. However, the authors did not describe the process used to select the studies and study validity was not formally assessed. Details of the primary studies were tabulated. The narrative synthesis was appropriate given the heterogeneity between studies, The authors' overall conclusion appears reliable, but the lack of study quality assessment and the limited reporting of individual studies make it difficult to assess the evidence presented.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors stated that further trials are warranted to delineate optimal fluid regimens in particular indications (e.g. hypoalbuminaemia and burns), and to define more precisely the appropriate roles for albumin in particular indications and populations.

Funding

Plasma Protein Therapeutics Association.

Bibliographic details

Haynes G R, Navickis R J, Wilkes M M. Albumin administration: what is the evidence of clinical benefit? A systematic review of randomized controlled trials European Journal of Anaesthesiology 2003; 20(10): 771-779. [PubMed: 14580047]

Indexing Status

Subject indexing assigned by NLM

MeSH

Acute Disease; Albumins /administration & dosage /therapeutic use; Ascites /drug therapy; Brain Injuries /drug therapy; Burns /drug therapy; Humans; Hypoalbuminemia /drug therapy; Randomized Controlled Trials as Topic /statistics & numerical data; Sepsis /drug therapy; Surgical Procedures, Operative /statistics & numerical data; Treatment Outcome

AccessionNumber

12003006863

Database entry date

31/05/2007

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.