Albumin for resuscitation and volume expansion in critically ill patients

Evidence Summaries

Level of Evidence = B
Albumin administration appears not to reduce mortality in patients with hypovolaemia or in critically ill patients.

A Cochrane review 1 included 38 trials reporting death as outcome. There were 1,958 deaths among 10,842 trial participants.

For hypovolaemia, the relative risk of death following albumin administration was 1.02 (95% CI 0.92 to 1.13). This estimate was heavily influenced by the results of the SAFE trial which contributed 75.2% of the information (based on the weights in the meta-analysis). For burns, the relative risk was 2.93 (95% CI 1.28 to 6.72) and for hypoalbuminaemia the relative risk was 1.26 (95% CI 0.84 to 1.88). There was no substantial heterogeneity between the trials in the various categories. The pooled relative risk of death with albumin administration was 1.05 (95% CI 0.95 to 1.16).

Another Cochrane review 2 included 69 studies with 30,020 participants comparing colloids to crystalloids in patients requiring volume replacement. There was no clear evidence that colloids (starches, dextrans, gelatins, and albumin) reduce the risk of death, compared to crystalloids, in patients with trauma, burns or following surgery (table T1).


Table 1. Albumin and fresh frozen plasma compared to crystalloid for fluid resuscitation
Outcome Relative effect (95% CI) Risk with crystalloids Risk with albumin (95% CI) Number of participants (studies) Certainty of the evidence
All-cause mortality (at end of follow-up) RR 0.98 (0.92 to 1.06) 254 per 1000 249 per 1000 (234 to 270) 13,047 (20) Moderate
All-cause mortality (at 90 days) RR 0.98 (0.92 to 1.04) 259 per 1000 254 per 1000 (239 to 270) 12,492 (10) Moderate
Transfusion of blood products RR 1.31 (0.95 to 1.80) 290 (3 281 per 1000 368 per 1000 (267 to 506) 290 (3) Very low
Renal replacement therapy RR 1.11 (0.96 to 1.27) 201 per 1000 223 per 1000 (193 to 255) 3028 (2) Low

Comment: The quality of evidence is downgraded by study limitations (inadequate allocation concealment).

References

1. Roberts I, Blackhall K, Alderson P et al. Human albumin solution for resuscitation and volume expansion in critically ill patients. Cochrane Database Syst Rev 2011;(11):CD001208.  [PMID:22071799]
2. Lewis SR, Pritchard MW, Evans DJ et al. Colloids versus crystalloids for fluid resuscitation in critically ill people. Cochrane Database Syst Rev 2018;(8):CD000567.  [PMID:30073665]

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