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7 August 2001 | Volume 135 Issue 3 | Pages 149-164
Purpose: To test the hypothesis that albumin administration is not associated with excess mortality.
Data Sources: Computer searches of the MEDLINE and EMBASE databases, the Cochrane Library, and Internet documents; hand searching of medical journals; inquiries to investigators and medical directors; and review of reference lists.
Study Selection: Randomized, controlled trials comparing albumin therapy with crystalloid therapy, no albumin, or lower doses of albumin.
Data Extraction: Two investigators independently extracted data. The primary end point was relative risk for death. Criteria used to assess methodologic quality were blinding, method of allocation concealment, presence of mortality as a study end point, and crossover. Small-trial bias was also investigated.
Data Synthesis: Fifty-five trials involving surgery or trauma, burns, hypoalbuminemia, high-risk neonates, ascites, and other indications were included. Albumin administration did not significantly affect mortality in any category of indications. For all trials, the relative risk for death was 1.11 (95% CI, 0.95 to 1.28). Relative risk was lower among trials with blinding (0.73 [CI, 0.48 to 1.12]; n = 7), mortality as an end point (1.00 [CI, 0.84 to 1.18]; n = 17), no crossover (1.04 [CI, 0.89 to 1.22]; n = 35), and 100 or more patients (0.94 [CI, 0.77 to 1.14]; n = 10). In trials with two or more such attributes, relative risk was further reduced.
Conclusions: Overall, no effect of albumin on mortality was detected; any such effect may therefore be small. This finding supports the safety of albumin. The influence of methodologic quality on relative risk for death suggests the need for further well-designed clinical trials.
Author and Article Information
From Hygeia Associates, Grass Valley, California.
Grant Support: By the Plasma Protein Therapeutics Association and the American Red Cross.
Requests for Single Reprints: Mahlon M. Wilkes, PhD, Hygeia Associates, 17988 Brewer Road, Grass Valley, CA 95949; e-mail, mwilkes{at}hygeiaassociates.com.
Current Author Addresses: Drs. Wilkes and Navickis: Hygeia Associates, 17988 Brewer Road, Grass Valley, CA 95949.
Author Contributions: Conception and design: M.M. Wilkes, R.J. Navickis.
Analysis and interpretation of the data: M.M. Wilkes, R.J. Navickis.
Drafting of the article: M.M. Wilkes, R.J. Navickis.
Critical revision of the article for important intellectual content: M.M. Wilkes, R.J. Navickis.
Final approval of the article: M.M. Wilkes, R.J. Navickis.
Statistical expertise: M.M. Wilkes.
Obtaining of funding: M.M. Wilkes, R.J. Navickis.
Administrative, technical, or logistic support: M.M. Wilkes, R.J. Navickis.
Collection and assembly of data: M.M. Wilkes, R.J. Navickis. ARTICLE
Patient Survival after Human Albumin Administration
A Meta-Analysis of Randomized, Controlled Trials
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