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Mahlon and Navickis (2001)
| 55 randomised controlled trials comparing albumin therapy with other interventions | Systematic review (level 1a) | Relative risk of death | Pooled relative risk for death was 1.11 (95% CI 0.95 to 1.28). Relative risk for death in hypoalbuminaemia group was 1.59 (95% CI 0.91 to 2.78). Overall, no effect of albumin on mortality detected | Relative risk was lower in trials with blinding, mortality as end point, no crossover, and 100 or more patients. Only 5 trials dealt with patients with hypoalbuminaemia |
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Alderson et al (2001)
| 30 randomised controlled trials comparing albumin with other interventions in critically ill patients | Systematic review (level 1a) | Mortality | For hypoalbuminaemia relative risk of death was 1.69 (95% CI 1.07 to 2.67). Pooled relative risk of death with albumin was 1.68 (95% CI 1.26 to 2.23). The risk of death in the albumin treated group was higher than in the comparison group | Large peer response (BMJ 1998;317:882, 1999;318:464, 1214). Small trial bias, lack of enough trials in the paediatric population and concerns over homogeneity through the trials |
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Blunt et al (1998)
| 145 survivors and non-survivors of prolonged critical illness | Retrospective review of practice (level 4) | COP and mortality | Non-survivors had significantly lower mean serum albumin compared with survivors; p<0.05. Albumin only contributed to 17% of the COP in critically ill patients. There was no relation between death and COP | Adult pattern disease: one half of this population were postoperative patients, e.g. aortic aneurysm, gastrointestinal and renal patients |
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Grundmann and Heistermann (1985)
| 220 patients on adult ITU randomised to receive albumin when COP fell <24 cm H2O (group 1) or COP <29 cm H2O (group 2) | Prospective randomised controlled trial (level 1b) | Postoperative complications, COP, duration of intensive care and mortality | Albumin replacement did not influence the final outcome. The 95% CI of risk difference for mortality includes zero (−5.4%, −16.6 to 5.8%). The absolute risk increase of lower COP (<20 cm H2O) for mortality was 50.5% (95% CI 20.5 to 80.5%) | Both groups received albumin. All patients were postoperative |