Review: albumin administration is not associated with excess mortality in acutely ill patients.

QUESTION: Is albumin administration associated with excess mortality in acutely ill patients?Data sourcesPublished and unpublished trials were identified by searching Medline, EMBASE/Excerpta Medica, the Cochrane Controlled Trials Register, and the Cochrane Medical Editors Trial Amnesty of unpublished trials; by searching Altavista, Northern Light, HotBot, and Excite search engines for relevant internet resources; by handsearching, JAMA, New England, Journal of Medicine, Lancet, and BMJ from January 1990 to November 2000; contacting albumin suppliers and authors of published randomised trials; and reviewing bibliographies of previous meta-analyses, review articles, and other investigations involving albumin. Studies in any language were considered.Study selectionStudies were selected if they were randomised controlled trials comparing intravenous albumin treatment with crystalloid treatment, no purified albumin, or a lower dose of purified albumin; and had available mortality data. There were no restrictions on the clinical indication for albumin administration or therapeutic intent Studies were not excluded if concomitant treatments were given in a similar manner to both study groups. Studies were excluded if the control group tested synthetic colloids, blood products, or plasma protein fraction.Data extractionData were extracted on clinical setting, study population, details of albumin and control regimens, study endpoints, study quality, and outcomes. Main outcome measure was mortality.Main results55 trials (n=3504) met the inclusion criteria. Duration of follow up was available for 49 trials; median duration of follow up was 11 days (range 0.04 to 1096 d). 13 trials were not included in the pooled analysis because no patients died in either group. Of the remaining 42 trials, there was no statistically significant difference in mortality between intervention and control groups (table). The relative risk of death was lower in trials that had blinding, >/= 100 patients, mortality as an endpoint, and in those without crossovers.ConclusionIn acutely ill patients, albumin administration is not associated with differences in mortality.