Table 1
CitationStudy groupStudy type (level of evidence)OutcomeKey resultsComments
Mahlon and Navickis (2001) 55 randomised controlled trials comparing albumin therapy with other interventionsSystematic review (level 1a)Relative risk of deathPooled 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 detectedRelative 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
Alderson et al (2001) 30 randomised controlled trials comparing albumin with other interventions in critically ill patientsSystematic review (level 1a)MortalityFor 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 groupLarge 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
Blunt et al (1998) 145 survivors and non-survivors of prolonged critical illnessRetrospective review of practice (level 4)COP and mortalityNon-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 COPAdult pattern disease: one half of this population were postoperative patients, e.g. aortic aneurysm, gastrointestinal and renal patients
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 mortalityAlbumin 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