Albumin versus Other Fluids for Fluid Resuscitation in Patients with Sepsis: A Meta-Analysis

Abstract

BackgroundEarly fluid resuscitation is vital to patients with sepsis. However, the choice of fluid has been a hot topic of discussion. The objective of this study was to evaluate whether the use of albumin-containing fluids for resuscitation in patients with sepsis was associated with a decreased mortality rate.MethodsWe systematically searched PubMed, EMBASE and Cochrane library for eligible randomized controlled trials (RCTs) up to March 2014. The selection of eligible studies, assessment of methodological quality, and extraction of all relevant data were conducted by two authors independently.ResultsIn total, 15 RCTs were eligible for analysis. After pooling the data, we found there was no significant effect of albumin-containing fluids on mortality in patients with sepsis of any severity (RR: 0.94, 95% CI: 0.87, 1.02 and RD: –0.01, 95% CI: –0.03, 0.01). The results were robust to subgroup analyses, sensitivity analyses and trial sequential analyses.ConclusionThe present meta-analysis did not demonstrate significant advantage of using albumin-containing fluids for resuscitation in patients with sepsis of any severity. Given the cost-effectiveness of using albumin, crystalloids should be the first choice for fluid resuscitation in septic patients.

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

“…Since the 2012 SSC guideline publication, six systematic reviews/meta-analyses [237,[241][242][243][244][245] were published assessing the use of albumin solutions in the management of patients with sepsis or septic shock. Each meta-analysis included different populations (adult/child, septic/nonseptic, and acute resuscitation/maintenance), different comparators and different duration of exposure to the intervention (hours, days), which made combining data challenging (ESM 7).…”

“…Albumin use resulted in reduced septic shock 90-day mortality (OR 0.81; 95% CI 0.67-0.97) and trended toward reduced 90-day mortality in sepsis (OR 0.88; 95% CI 0.76-1.01; p = 0.08). Jiang et al [245] evaluated albumin in a mixed population of sepsis severity including adults and children. Three septic shock studies, encompassing 1931 patients, were included.…”

The effect of crystalloid infusion on body water content and intra-abdominal pressure in patients undergoing orthopedic surgery under spinal anesthesia

“…There is increasing evidence that fluid infusion affects postoperative outcomes, and plays a crucial role in critically ill patients. 8,9,13,14 Excessive perioperative fluid loading leads to extravascular fluid accumulation and weight gain, which corresponds with increased mortality and morbidity during the early postoperative period. 6,8,15 Several meta-analyses have reported that goaloriented fluid therapy significantly reduces renal and pulmonary postoperative complications, and accelerates the first bowel movement, the resumption of normal diet, and shortens the length of stay in hospital.…”

Fluid Resuscitation, Which Fluid is the Best for Each Patient? A Systematic Review and Meta Analysis

“…Ten (38 percent) of the included studies were in sepsis (4,5,8,17,18,23,32,34,40,41), two (7 percent) in ICU (22, 31), 3 (11 percent) in trauma (26,28,36), two (7 percent) in hypovolemic shock (14,38), one (3 percent) in abdominal surgery (25), one (3 percent) in burn (16), one (3 percent) in pulmonary insufficiency (30), one (3 percent) in hypovolemic/septic (35), and five (22 percent) in other critically illnesses.…”

“…Nevertheless, there are prominent challenges associated with the use of subgroup analyses in drawing conclusions (3). The previous meta-analyses conducted to evaluate the albumin solutions' effectiveness in resuscitation process have focused on patients with critical illnesses and patients with hypoalbuminemia and burns (4)(5)(6)(7)(8)(9). There have been inadequate systematic reviews defining the most appropriate resuscitation fluid for different patients (4,7,(9)(10)(11)(12), and there is a lack of indications re- garding the use of colloid or crystalloid.…”