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Centre for Evidence-
Based Medicine

Hypovolemia: Albumin increases mortality in critically ill patients

Clinical Bottom Line

In critically ill patients, the use of albumin compared to crystalloid for volume resuscitation is associated with increased mortality.

Citation

Roberts I. Cochrane injuries group albumin reviewers.
BMJ 1998;317:235-240.

Clinical Question

In critically ill patients, does the use of albumin compared to crystalloid for volume resuscitation increase mortality

Search Terms

Colloid and mortality in Cochrane.database of systematic reviews.

The Study

A systematic review of randomized clinical trials that evaluated whether the use of albumin compared with crystalloid for volume resuscitation is associated with mortality in critically ill patients.

The Evidence

Outcome CER EER RRR ARR [95% CI] NNT [95% CI]
Death in all patients 10% 16% 60% 6% [3% - 9%] 17 [11 - 33]

Comments

  1. The association between use of albumin and mortality was consistent across the subgroups analyzed:
    • Hypovolemia RR of death with albumin: 1.46 (95% CI 0.97-2.22)
    • Burns RR of death with albumin: 2.40 (95% CI 1.11 - 5.19)
    • Hypoalbuminemia RR of death with albumin: 1.69 (95% CI 1.07-2.67)
  2. Many of the studies included in the analysis had weak methods. Most did not use blinded outcome assessment and most did not describe timing of the intervention of co-interventions. Nevertheless, none of the data suggest that the use of albumin is beneficial

Appraised By

Pronovost 1999

Expiry Date

2000