Overall, the meta analysis was robust to sensitivity, subgroup, meta regression, and trial sequential analyses.Conclusions In this analysis, human albumin solutions as part of fluid volume expansion and resuscitation for critically unwell adults with sepsis of any severity (with or without baseline hypoalbuminaemia) were not robustly effective at reducing all cause mortality. Albumin seems to be safe in this setting, as a signal towards harm was not detected, but this analysis does not support a recommendation for use.IntroductionThe use of colloid fluids is controversial and neither the efficacy nor safety of pooled human albumin solutions has been adequately demonstrated in randomised trials or meta analyses.1 2 3 4 Uncertainty has resulted in continued global5 albumin use and associated expense.6 Human albumin is a natural colloid used as part of volume expansion and resuscitation and to correct hypoalbuminaemia.7 8 Sepsis, severe sepsis, and septic shock have a high mortality in adults of 24 39% in hospital9 or at 28 days and 33 50% at 90 days.10 11 Fluid volume expansion and resuscitation of these critically ill patients with albumin is recommended by both the UK National Institute for Health and Care Excellence (NICE)12 and the Surviving Sepsis Campaign (GRADE 2C), based on limited evidence that is of low quality.13 14 15 The SAFE study7 reported no difference in mortality between human albumin and crystalloid (P=0.09) in 1218 randomised adults with severe sepsis, of whom 36% had septic shock.8 However, mortality reduction was reported when a subgroup (76%) with available data on covariates was subjected to multivariate logistic regression analysis (P=0.03), supported by persistent Kaplan Meier survival curve separation observed after approximately eight days.8 Furthermore pandora charms https://www.pandorasalesbracelet.com/, the use of albumin to correct or improve hypoalbuminaemia is controversial. Cohort studies associate hypoalbuminaemia with increased morbidity and mortality in both heterogeneous16 and septic17 patients in critical or intensive care.
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