Whether Albumin Therapy Improves or Worsens Survival of Critically Ill Patients Is Not Known

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The summary below is from the full report titled, "Patient Survival after Human Albumin Administration. A Meta-Analysis of Randomized, Controlled Trials." It is in the 7 August 2001 issue of Annals of Internal Medicine (volume 135, pages 149-164). The authors are MM Wilkes and RJ Navickis.

What is the problem and what is known about it so far?

Albumin is a protein normally found in blood. Solutions of human albumin can be given to patients through their veins (intravenously). These products are expensive and sometimes difficult to get. Albumin is usually given to people who are very ill, such as those who have severe burns, serious trauma, major surgery, shock, life-threatening infections, or liver failure. Treatment with albumin may increase blood protein levels, circulating blood volume, and blood pressure when they are abnormally low. However, whether albumin improves or worsens the chance of survival of critically ill patients is controversial.

Why did the researchers do this particular study?

To find out whether treatment with albumin worsens or improves survival in critically ill patients.

Who was studied?

Rather than perform another study of treatment with albumin, the researchers looked at information on 3504 patients who had participated in previously published studies of the use of albumin. Most patients were adults, and about 10% were infants. More than one third of the patients had major surgery or serious trauma; 10% had liver failure; and about 5% had severe burns.

How was the study done?

The researchers analyzed information from 55 previous studies that had randomly assigned seriously ill patients to receive either albumin or other treatments. These other treatments included intravenous fluids that did not contain albumin; "usual" care, without albumin; or smaller and less frequent doses of albumin. Half the studies had about 50 participants or fewer. Patients were generally followed for a few days to 2 weeks. The researchers compared the number of deaths among patients given albumin and those given alternative regimens. They also did special analyses that tried to account for some of the problems of the 55 studies, such as small size and poorer designs.

What did the researchers find?

About 15% of all patients died. Albumin neither improved nor worsened survival compared with other treatments that involved no or little albumin. The special analyses suggested, but did not prove, that treatment with albumin may benefit some patients. None of the special analyses found that albumin treatment worsened a patient's chance of survival.

What were the limitations of the study?

Patients in these studies had many different types of severe illnesses: for example, severe burns or liver failure. Whether albumin was beneficial for patients with particular problems and harmful for those with other conditions was not definitively established. The wide variety of alternative treatments that were compared with albumin, as well as the short and varying periods of follow-up, increase the difficulty of judging whether albumin was effective.

What are the implications of the study?

Whether albumin improves or worsens survival of critically ill patients is still not known.