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Critical Care
Published in: Critical Care 6/2014

Open Access 01-12-2014 | Research

Comparison of the effects of albumin and crystalloid on mortality in adult patients with severe sepsis and septic shock: a meta-analysis of randomized clinical trials

Authors: Jing-Yuan Xu, Qi-Hong Chen, Jian-Feng Xie, Chun Pan, Song-Qiao Liu, Li-Wei Huang, Cong-Shan Yang, Ling Liu, Ying-Zi Huang, Feng-Mei Guo, Yi Yang, Hai-Bo Qiu

Published in: Critical Care | Issue 6/2014

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Abstract

Introduction

The aim of this study was to examine whether albumin reduced mortality when employed for the resuscitation of adult patients with severe sepsis and septic shock compared with crystalloid by meta-analysis.

Methods

We searched for and gathered data from MEDLINE, Elsevier, Cochrane Central Register of Controlled Trials and Web of Science databases. Studies were eligible if they compared the effects of albumin versus crystalloid therapy on mortality in adult patients with severe sepsis and septic shock. Two reviewers extracted data independently. Disagreements were resolved by discussion with other two reviewers until a consensus was achieved. Data including mortality, sample size of the patients with severe sepsis, sample size of the patients with septic shock and resuscitation endpoints were extracted. Data were analyzed by the methods recommended by the Cochrane Collaboration Review Manager 4.2 software.

Results

A total of 5,534 records were identified through the initial search. Five studies compared albumin with crystalloid. In total, 3,658 severe sepsis and 2,180 septic shock patients were included in the meta-analysis. The heterogeneity was determined to be non-significant (P = 0.86, I2 = 0%). Compared with crystalloid, a trend toward reduced 90-day mortality was observed in severe sepsis patients resuscitated with albumin (odds ratio (OR) 0.88; 95% CI, 0.76 to 1.01; P = 0.08). However, the use of albumin for resuscitation significantly decreased 90-day mortality in septic shock patients (OR 0.81; 95% CI, 0.67 to 0.97; P = 0.03). Compared with saline, the use of albumin for resuscitation slightly improved outcome in severe sepsis patients (OR 0.81; 95% CI, 0.64 to 1.08; P = 0.09).

Conclusions

In this meta-analysis, a trend toward reduced 90-day mortality was observed in severe sepsis patients resuscitated with albumin compared with crystalloid and saline. Moreover, the 90-day mortality of patients with septic shock decreased significantly.
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Literature
1.
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M, Early Goal-Directed Therapy Collaborative Group: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001, 345: 1368-1377. 10.1056/NEJMoa010307.CrossRef
2.
Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, Pike F, Terndrup T, Wang HE, Hou PC, LoVecchio F, Filbin MR, Shapiro NI, Augus DC, ProCESS Investigators: A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014, 370: 1683-1693. 10.1056/NEJMoa1401602.CrossRef
3.
Lilly CM: The ProCESS trial - a new era of sepsis management. N Engl J Med. 2014, 370: 1750-1751. 10.1056/NEJMe1402564.CrossRef
4.
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb SA, Beale RJ, Vincent JL, Moreno R, Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup: Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Crit Care Med. 2013, 41: 580-637. 10.1097/CCM.0b013e31827e83af.CrossRef
5.
Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R, SAFE Study Investigators: A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004, 350: 2247-2256. 10.1056/NEJMoa040232.CrossRef
6.
Finfer S, McEvoy S, Bellomo R, McArthur C, Myburgh J, Norton R, SAFE Study Investigators: Impact of albumin compared to saline on organ function and mortality of patients with severe sepsis. Intensive Care Med. 2011, 37: 86-96. 10.1007/s00134-010-2081-4.CrossRef
7.
Delaney AP, Dan A, McCaffrey J, Finfer S: The role of albumin as a resuscitation fluid for patients with sepsis: a systematic review and meta-analysis. Crit Care Med. 2011, 39: 386-391. 10.1097/CCM.0b013e3181ffe217.CrossRef
8.
Patel A, Laffan MA, Waheed U, Brett SJ: Randomised trials of human albumin for adults with sepsis: systematic review and meta-analysis with trial sequential analysis of all-cause mortality. BMJ. 2014, 349: g4561-10.1136/bmj.g4561.CrossRef
9.
Caironi P, Tognoni G, Masson S, Fumagalli R, Pesenti A, Romero M, Fanizza C, Caspani L, Faenza S, Grasselli G, Iapichino G, Antonelli M, Parrini V, Fiore G, Latini R, Gattinoni L, ALBIOS Study Investigators: Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med. 2014, 370: 1412-1421. 10.1056/NEJMoa1305727.CrossRef
10.
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ: Assessing the quality of reports of randomized clinical trials: is blinding necessary. Control Clin Trials. 1996, 17: 1-12. 10.1016/0197-2456(95)00134-4.CrossRef
11.
Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Cochrane Bias Methods Group, Cochrane Statistical Methods Group: The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011, 343: d5928-10.1136/bmj.d5928.CrossRef
12.
Haupt MT, Rackow EC: Colloid osmotic pressure and fluid resuscitation with hetastarch, albumin, and saline solutions. Crit Care Med. 1982, 10: 159-162. 10.1097/00003246-198203000-00004.CrossRef
13.
Rackow EC, Falk JL, Fein IA, Siegel JS, Packman MI, Haupt MT, Kaufman BS, Putnam D: Fluid resuscitation in circulatory shock: a comparison of the cardiorespiratory effects of albumin, hetastarch, and saline solutions in patients with hypovolemic and septic shock. Crit Care Med. 1983, 11: 839-850. 10.1097/00003246-198311000-00001.CrossRef
14.
Annane D, Siami S, Jaber S, Martin C, Elatrous S, Declere AD, Preiser JC, Outin H, Troche G, Charpentier C, Trouillet JL, Kimmoun A, Forceville X, Darmon M, Lesur O, Reignier J, Abroug F, Berger P, Clech C, Cousson J, Thibault L, Chevret S, CRISTAL Investigators: Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock: the CRISTAL randomized trial. JAMA. 2013, 310: 1809-1817. 10.1001/jama.2013.280502.CrossRef
15.
Metildi LA, Shackford SR, Virgilio RW, Peters RM: Crystalloid versus colloid in fluid resuscitation of patients with severe pulmonary insufficiency. Surg Gynecol Obstet. 1984, 158: 207-212.
16.
Perel P, Roberts I, Ker K: Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2013, 2: CD000567-
17.
Vincent JL, Dubois MJ, Navickis RJ, Wilkes MM: Hypoalbuminemia in acute illness: is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials. Ann Surg. 2003, 237: 319-334.
18.
Wilkes MM, Navickis RJ: Patient survival after human albumin administration. A meta-analysis of randomized, controlled trials. Ann Intern Med. 2001, 135: 149-164. 10.7326/0003-4819-135-3-200108070-00007.CrossRef
19.
Cochrane Injuries Group Albumin Reviewers: Human albumin administration in critically ill patients: systematic review of randomised controlled trials. BMJ. 1998, 317: 235-240. 10.1136/bmj.317.7153.235.CrossRef
20.
Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R: Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000–2012. JAMA. 2014, 311: 1308-1316. 10.1001/jama.2014.2637.CrossRef
21.
Myburgh JA, Finfer S, Bellomo R, Billot L, Cass A, Gattas D, Glass P, Lipman J, Liu B, McArthur C, McGuinness S, Rajbhandari D, Taylor CB, Webb SA, CHEST Investigators, Australian and New Zealand Intensive Care Society Clinical Trials Group: Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med. 2012, 367: 1901-1911. 10.1056/NEJMoa1209759.CrossRef
22.
Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, Moerer O, Gruendling M, Oppert M, Grond S, Olthoff D, Jaschinski U, John S, Rossaint R, Welte T, Schaefer M, Kern P, Kuhnt E, Kiehntopf M, Hartog C, Natanson C, Loeffler M, Reinhart K, German Competence Network Sepsis (SepNet): Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med. 2008, 358: 125-139. 10.1056/NEJMoa070716.CrossRef
23.
Weil MH, Henning RJ, Puri VK: Colloid oncotic pressure: clinical significance. Crit Care Med. 1979, 7: 113-116. 10.1097/00003246-197903000-00006.CrossRef
24.
American Thoracic Society: Evidence-based colloid use in the critically ill: American Thoracic Society Consensus Statement. Am J Respir Crit Care Med. 2004, 170: 1247-1259. 10.1164/rccm.200208-909ST.CrossRef
25.
Sudlow G, Birkett DJ, Wade DN: The characterization of two specific drug binding sites on human serum albumin. Mol Pharmacol. 1975, 11: 824-832.
26.
Quinlan GJ, Margarson MP, Mumby S, Evans TW, Gutteridge JM: Administration of albumin to patients with sepsis syndrome: a possible beneficial role in plasma thiol repletion. Clin Sci (Lond). 1998, 95: 459-465. 10.1042/CS19980191.CrossRef
27.
King TP: On the sulfhydryl group of human plasma albumin. J Biol Chem. 1961, 236: C5-
28.
Doweiko JP, Bistrian BR: The effect of glycosylated albumin on platelet aggregation. JPEN J Parenter Enteral Nutr. 1994, 18: 516-520. 10.1177/0148607194018006516.CrossRef
29.
Verheij J, van Lingen A, Raijmakers PG, Rijnsburger ER, Veerman DP, Wisselink W, Girbes AR, Groeneveld AB: Effect of fluid loading with saline or colloids on pulmonary permeability, oedema and lung injury score after cardiac and major vascular surgery. Br J Anaesth. 2006, 96: 21-30. 10.1093/bja/aei286.CrossRef
30.
Wang R, Lagakos SW, Ware JH, Hunter DJ, Drazen JM: Statistics in medicine–reporting of subgroup analyses in clinical trials. N Engl J Med. 2007, 357: 2189-2194. 10.1056/NEJMsr077003.CrossRef
Metadata
Title
Comparison of the effects of albumin and crystalloid on mortality in adult patients with severe sepsis and septic shock: a meta-analysis of randomized clinical trials
Authors
Jing-Yuan Xu
Qi-Hong Chen
Jian-Feng Xie
Chun Pan
Song-Qiao Liu
Li-Wei Huang
Cong-Shan Yang
Ling Liu
Ying-Zi Huang
Feng-Mei Guo
Yi Yang
Hai-Bo Qiu
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Critical Care / Issue 6/2014
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-014-0702-y

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