Abstract | BACKGROUND: OBJECTIVES: SEARCH STRATEGY: We searched the Cochrane Injuries Group trials register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and BIDS Index to Scientific and Technical Proceedings. Reference lists of trials and review articles were checked, and authors of identified trials were contacted. The search was last updated in August 2004. SELECTION CRITERIA: DATA COLLECTION AND ANALYSIS: We collected data on the participants, albumin solution used, mortality at the end of follow up, and quality of allocation concealment. Analysis was stratified according to patient type. MAIN RESULTS: We found 32 trials meeting the inclusion criteria and reporting death as an outcome. There were 1632 deaths among 8452 trial participants. For hypovolaemia, the relative risk of death following albumin administration was 1.01 (95% confidence interval 0.92, 1.10). This estimate was heavily influenced by the results of the SAFE trial which contributed 91% of the information (based on the weights in the meta-analysis). For burns, the relative risk was 2.40 (1.11, 5.19) and for hypoalbuminaemia the relative risk was 1.38 (0.94, 2.03). There was no substantial heterogeneity between the trials in the various categories (chi-square = 21.86, df = 25, p =0.64). The pooled relative risk of death with albumin administration was 1.04 (0.95, 1.13). REVIEWERS' CONCLUSIONS: For patients with hypovolaemia there is no evidence that albumin reduces mortality when compared with cheaper alternatives such as saline. There is no evidence that albumin reduces mortality in critically ill patients with burns and hypoalbuminaemia. The possibility that there may be highly selected populations of critically ill patients in which albumin may be indicated remains open to question. However, in view of the absence of evidence of a mortality benefit from albumin and the increased cost of albumin compared to alternatives such as saline, it would seem reasonable that albumin should only be used within the context of well concealed and adequately powered randomised controlled trial.
|
Authors | P Alderson, F Bunn, C Lefebvre, Wan Po A Li, L Li, I Roberts, G Schierhout, Albumin Reviewers |
Journal | The Cochrane database of systematic reviews
(Cochrane Database Syst Rev)
Issue 4
Pg. CD001208
(Oct 18 2004)
ISSN: 1469-493X [Electronic] England |
PMID | 15495011
(Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
|
Chemical References |
- Blood Proteins
- Plasma Substitutes
- Serum Albumin
- Serum Globulins
- plasma protein fraction
- Serum Albumin, Human
|
Topics |
- Blood Proteins
(therapeutic use)
- Critical Illness
(mortality, therapy)
- Fluid Therapy
- Humans
- Plasma Substitutes
(therapeutic use)
- Randomized Controlled Trials as Topic
- Serum Albumin
(therapeutic use)
- Serum Albumin, Human
- Serum Globulins
|