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Morbidity in hospitalized patients receiving human albumin: A meta-analysis of randomized, controlled trials*

2004; Lippincott Williams & Wilkins; Volume: 32; Issue: 10 Linguagem: Inglês

10.1097/01.ccm.0000142574.00425.e9

1530-0293

Jean‐Louis Vincent, Roberta J. Navickis, Mahlon M. Wilkes,

Hemodynamic Monitoring and Therapy

Objective: To determine the effect of albumin administration on morbidity in acutely ill hospitalized patients. Data Source: Computer searches of MEDLINE, EMBASE, and the Cochrane Library; hand searches of journals and Index Medicus; inquiries with investigators and fluid product suppliers; and examination of reference lists. No language or time period restrictions were adopted. Study Selection: Randomized, controlled trials comparing the administration of albumin with that of crystalloid, no albumin, or lower-dose albumin. Data Extraction: Two investigators independently extracted data. The primary endpoint for the meta-analysis was morbidity, defined as the incidence of complications, including death. Trial quality was evaluated by blinding, allocation concealment, presence of morbidity as a study endpoint, and individual patient crossover. Data Synthesis: Seventy-one trials were included in the categories of surgery or trauma, burns, hypoalbuminemia, high-risk neonates, ascites, and other indications. The 3,782 randomized patients in the included trials experienced a total of 3,287 complications, including 515 deaths and 2,772 cardiovascular, gastrointestinal, hepatic, infectious, renal, respiratory, and other complications. Albumin significantly reduced overall morbidity, with a risk ratio of 0.92 (confidence interval [CI], 0.86–0.98). Control group albumin dose significantly affected the incidence of complications (p = .002). In 32 trials with no albumin administered to the control group, the risk ratio was 0.77 (CI, 0.67–0.88) compared with 0.89 (CI, 0.80–1.00) in 20 trials with control patients receiving low-dose albumin and 1.07 (CI, 0.96–1.20) in 19 trials with moderate-dose control group albumin. Conclusions: Albumin reduces morbidity in acutely ill hospitalized patients. Concomitant administration of albumin in the control group can obscure the effects of albumin on clinical outcome in randomized trials.