Efficacy and Safety of Albumin in Critically Ill Adults: A Systematic Review

Albumin, the most abundant blood protein, is widely used as a plasma expander in critically ill patients.

To evaluate the efficacy and safety of albumin compared to other alternatives in the prevention and treatment of complications in critically ill adults, considering different comparators and clinical situations.

A systematic review was conducted, including randomized controlled trials (RCTs) comparing albumin with crystalloids, other colloids, or standard care without albumin. Primary outcomes were total mortality, blood transfusion requirement, and serious adverse events. The search was performed in MEDLINE, Embase, and Cochrane Central. Meta-analysis was conducted using the Mantel-Haenszel method with a random-effects model, and heterogeneity was assessed with the I² statistic. The risk of bias was evaluated using Cochrane RevMan 5.4, and the quality of evidence was assessed with the GRADE approach.

Thirty-five RCTs involving 13,975 critically ill adults were included. Mortality was 23.8% (1327/5586) with albumin and 24.2% (1361/5618). Compared with colloids, mortality was 21.9% (83/379) versus 24.4% (113/463). When compared with standard care without albumin, mortality was higher with albumin: 15.8% (60/380) versus 9.2% (39/424). SAEs occurred in 37.6% (298/793) of albumin-treated patients versus 33.5% (266/793) with crystalloids. Albumin required less transfused blood volume than colloids.

Albumin showed no benefit over crystalloids, colloids, or standard care without albumin in reducing mortality. It resulted in less blood transfusions compared to colloids, but serious adverse events were higher than with crystalloids.