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Albumin in Sepsis and Septic Shock: A Systematic Review and Meta-Analysis.
Uday Shree Akkala Shetty1, Ashutosh Sharma2, Ansharah-E-Zinnia Batool3
1Internal Medicine, Southern Regional Medical Center, Riverdale, GEO.
Cureus
|June 15, 2026
Summary
Human albumin solution in sepsis did not reduce mortality or kidney injury but did lower fluid balance. Further trials are needed to clarify albumin
Area of Science:
- Critical Care Medicine
- Nephrology
- Pharmacology
Background:
- Sepsis and septic shock are major causes of ICU mortality globally.
- The choice of resuscitation fluid for sepsis management remains controversial.
- Human albumin solution is a potential fluid resuscitation agent.
Purpose of the Study:
- To systematically review and meta-analyze the effectiveness of human albumin solution versus control fluids in adults with sepsis or septic shock.
- To evaluate patient-centered outcomes including mortality, renal replacement therapy (RRT), acute kidney injury (AKI), and fluid balance.
- To explore potential concentration-dependent effects of albumin on renal outcomes.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies.
- Comprehensive literature search across major databases (MEDLINE, Embase, CENTRAL, CINAHL) up to March 2026.
- Pooled analysis using random-effects models to assess risk ratios and mean differences for key outcomes.
Main Results:
- Albumin administration showed no statistically significant reduction in all-cause mortality (RR 1.05, 95% CI 0.86-1.28).
- No significant difference was found in renal replacement therapy (RRT) requirement (RR 1.23, 95% CI 0.70-2.15) or acute kidney injury (AKI) incidence (RR 1.09, 95% CI 0.85-1.40).
- A statistically significant reduction in cumulative fluid balance was observed with albumin (MD -0.79 L, 95% CI -1.16 to -0.41).
- Subgroup analysis indicated a higher RRT risk with hyperoncotic albumin in patients with pre-existing renal impairment.
Conclusions:
- Albumin use in sepsis is associated with lower short-term cumulative fluid balance.
- Albumin does not appear to provide additional benefits regarding RRT or AKI in sepsis.
- Further adequately powered RCTs stratified by albumin concentration are required for definitive guidance on its use in sepsis.
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