Excess mortality after human albumin administration in critically ill patients

Clinical and pathophysiological evidence suggests albumin is harmful

Papers p 235 Letters p 277 Science commentary p 240

Albumin is a medium weight colloid which plays an essential role in generating the colloid-osmotic pressure. It facilitates fluid retention in the intravascular space. Human albumin is often given to critically ill patients with life threatening hypovolaemia. Low serum albumin concentrations are seen in various disease states and may be due to leakage, increased metabolism, or insufficient synthesis in the liver. The serum albumin concentration in critically ill patients seems to be inversely related to mortality.1 Yet does this observation imply that hypoalbuminaemia should be treated with albumin? In this week's issue a systematic review—published simultaneously in the Cochrane Library2 and a sequel to a paper on the controversy of whether critically ill patients with hypovolaemia should be given colloid or crystalloid fluids3—evaluates the use of human albumin in various clinical settings (p 235).4

The paper is clinically important because it suggests that a respected and widely used treatment given to neonates, children, and adults with hypovolaemia, burns, or hypoalbuminaemia is associated with increased mortality: on average six extra deaths for every 100 patients treated. The authors conclude that human albumin should not be given any more “outside the context of a rigorously conducted randomised controlled trial.”

Can we trust these findings? As systematic overviews of the medical literature are becoming more …