Meta analyses and misleading claims
The paper by Montori and his colleagues cites the Cochrane albumin
review (1) in the table. This review is an egregious example of a review
which made a misleading claim - in this case a 6 per cent additional
mortality when albumin was compared with saline in a meta-analysis.
The users` guide given by Montori is designed for the assessment of a
single randomised controlled trial (RCT); when many RCTs are amalgamated
into a review the compilers demand a degree of trust from those who use
their review for guidance. In dealing with a complex diverse subject,
such as critical illness, no ordinary reader, editor, or peer reviewer,
will examine critically all the RCTs from which the review`s authors`
conclusions were derived.
In the Cochrane albumin review 7 RCTs were adduced to support the
mistaken contention that albumin, used in the treatment of hypovolaemia,
would result in one additional death for every 17 patients when compared
with saline. Cogent criticism of each of these RCTs was documented (2)
and the author of the review did not answer any of them (3).
Reviews such as this are normally assessed by the Centre for Research
and Development (CRD) whose aim is to raise the general standard of
reviews in the NHS. The comment of the CRD on this review was "Cochrane
reviews are of a high standard and are not evaluated by a CRD reviewer".
It has taken 6 years for the SAFE study (4) to disprove the erroneous
allegation of the albumin review and so far there has been no retraction
by any member of the Cochrane Collaboration.
Peter J Horsey,
The Old Manor,
Hampshire SO20 6RH.
Tel 01794 388 256
1 Cochrane Injuries Group Albumin Revuers.
Human albumin administration in critically ill patients: systematic review
of randomised controlled trials. BMJ 1998; 317:235-40.
2 Horsey P Albumin and hypovolaemia: is the Cochrane evidence to be
trusted? Lancet 2002; 359:70-72.
3 Roberts I Albumin and hypovolaemia: time to move on and generate
new evidence. Lancet 2002; 359: 72-73.
4 Saline versus albumin study evaluation.
A comparison of saline and albumin for fluid resuscitation in the
intensive care unit. N Engl J Med 2004; 350:2247-56.
Competing interests: No competing interests