Human albumin is used in a range of medical and surgical patients in whom urgent restoration of blood volume is needed. Although human albumin is much more expensive than alternative solutions (twice the cost of hydroxyethyl starch and 30 times the cost of crystalloid solutions), it may help maintain the serum albumin concentration in critically ill patients. Previous studies have shown that the serum albumin concentration is inversely related to mortality. Each decrease of 2.5 g per L (3,790 μmol per L) in serum albumin concentration is associated with an increased risk of death of 24 to 56 percent. Because of concerns about the high cost and limited availability of human albumin, the Cochrane Injuries Group Albumin Reviewers performed an analysis of randomized clinical trials to quantify the effect on mortality of administering human albumin or plasma protein fraction during management of critically ill patients.
The reviewers identified 30 randomized controlled trials that met acceptable standards of quality. The studies included over 1,000 patients with burns, hypovolemia or hypoalbuminemia. The principal outcome measured was death.
Death occurred in 98 of 596 patients who received albumin, compared with 58 of 608 patients who received placebo. For pooled data, the relative risk of death after use of albumin was 1.68 (1.26 to 2.23). The relative risk of death was higher in each of the patient groups receiving human albumin but was highest in patients with burns. The relative risk of death was 2.40 (1.11 to 5.19) in burn patients receiving albumin solution, followed by patients with hypoalbuminemia, with a relative risk of death of 1.69 (1.07 to 2.67), and those with hypovolemia, with a relative risk of death of 1.46 (0.97 to 2.22) associated with albumin administration.
The authors conclude that the use of albumin may increase mortality in critically ill patients. The overall risk of death in patients who received albumin was increased by 6 percent. The authors found no evidence to support the previously reported protective effect of albumin, and they call for the use of this fluid to be restricted to rigorously controlled clinical trials.