Patient survival after human albumin administration. A meta-analysis of randomized, controlled trials

To test the hypothesis that albumin administration is not associated with excess mortality. Computer searches of the MEDLINE and EMBASE databases, the Cochrane Library, and Internet documents; hand searching of medical journals; inquiries to investigators and medical directors; and review of referen...

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Vydáno v:Annals of internal medicine Ročník 135; číslo 3; s. 149
Hlavní autoři: Wilkes, M M, Navickis, R J
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States 07.08.2001
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ISSN:0003-4819
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Abstract To test the hypothesis that albumin administration is not associated with excess mortality. Computer searches of the MEDLINE and EMBASE databases, the Cochrane Library, and Internet documents; hand searching of medical journals; inquiries to investigators and medical directors; and review of reference lists. Randomized, controlled trials comparing albumin therapy with crystalloid therapy, no albumin, or lower doses of albumin. Two investigators independently extracted data. The primary end point was relative risk for death. Criteria used to assess methodologic quality were blinding, method of allocation concealment, presence of mortality as a study end point, and crossover. Small-trial bias was also investigated. Fifty-five trials involving surgery or trauma, burns, hypoalbuminemia, high-risk neonates, ascites, and other indications were included. Albumin administration did not significantly affect mortality in any category of indications. For all trials, the relative risk for death was 1.11 (95% CI, 0.95 to 1.28). Relative risk was lower among trials with blinding (0.73 [CI, 0.48 to 1.12]; n = 7), mortality as an end point (1.00 [CI, 0.84 to 1.18]; n = 17), no crossover (1.04 [CI, 0.89 to 1.22]; n = 35), and 100 or more patients (0.94 [CI, 0.77 to 1.14]; n = 10). In trials with two or more such attributes, relative risk was further reduced. Overall, no effect of albumin on mortality was detected; any such effect may therefore be small. This finding supports the safety of albumin. The influence of methodologic quality on relative risk for death suggests the need for further well-designed clinical trials.
AbstractList To test the hypothesis that albumin administration is not associated with excess mortality. Computer searches of the MEDLINE and EMBASE databases, the Cochrane Library, and Internet documents; hand searching of medical journals; inquiries to investigators and medical directors; and review of reference lists. Randomized, controlled trials comparing albumin therapy with crystalloid therapy, no albumin, or lower doses of albumin. Two investigators independently extracted data. The primary end point was relative risk for death. Criteria used to assess methodologic quality were blinding, method of allocation concealment, presence of mortality as a study end point, and crossover. Small-trial bias was also investigated. Fifty-five trials involving surgery or trauma, burns, hypoalbuminemia, high-risk neonates, ascites, and other indications were included. Albumin administration did not significantly affect mortality in any category of indications. For all trials, the relative risk for death was 1.11 (95% CI, 0.95 to 1.28). Relative risk was lower among trials with blinding (0.73 [CI, 0.48 to 1.12]; n = 7), mortality as an end point (1.00 [CI, 0.84 to 1.18]; n = 17), no crossover (1.04 [CI, 0.89 to 1.22]; n = 35), and 100 or more patients (0.94 [CI, 0.77 to 1.14]; n = 10). In trials with two or more such attributes, relative risk was further reduced. Overall, no effect of albumin on mortality was detected; any such effect may therefore be small. This finding supports the safety of albumin. The influence of methodologic quality on relative risk for death suggests the need for further well-designed clinical trials.
To test the hypothesis that albumin administration is not associated with excess mortality.PURPOSETo test the hypothesis that albumin administration is not associated with excess mortality.Computer searches of the MEDLINE and EMBASE databases, the Cochrane Library, and Internet documents; hand searching of medical journals; inquiries to investigators and medical directors; and review of reference lists.DATA SOURCESComputer searches of the MEDLINE and EMBASE databases, the Cochrane Library, and Internet documents; hand searching of medical journals; inquiries to investigators and medical directors; and review of reference lists.Randomized, controlled trials comparing albumin therapy with crystalloid therapy, no albumin, or lower doses of albumin.STUDY SELECTIONRandomized, controlled trials comparing albumin therapy with crystalloid therapy, no albumin, or lower doses of albumin.Two investigators independently extracted data. The primary end point was relative risk for death. Criteria used to assess methodologic quality were blinding, method of allocation concealment, presence of mortality as a study end point, and crossover. Small-trial bias was also investigated.DATA EXTRACTIONTwo investigators independently extracted data. The primary end point was relative risk for death. Criteria used to assess methodologic quality were blinding, method of allocation concealment, presence of mortality as a study end point, and crossover. Small-trial bias was also investigated.Fifty-five trials involving surgery or trauma, burns, hypoalbuminemia, high-risk neonates, ascites, and other indications were included. Albumin administration did not significantly affect mortality in any category of indications. For all trials, the relative risk for death was 1.11 (95% CI, 0.95 to 1.28). Relative risk was lower among trials with blinding (0.73 [CI, 0.48 to 1.12]; n = 7), mortality as an end point (1.00 [CI, 0.84 to 1.18]; n = 17), no crossover (1.04 [CI, 0.89 to 1.22]; n = 35), and 100 or more patients (0.94 [CI, 0.77 to 1.14]; n = 10). In trials with two or more such attributes, relative risk was further reduced.DATA SYNTHESISFifty-five trials involving surgery or trauma, burns, hypoalbuminemia, high-risk neonates, ascites, and other indications were included. Albumin administration did not significantly affect mortality in any category of indications. For all trials, the relative risk for death was 1.11 (95% CI, 0.95 to 1.28). Relative risk was lower among trials with blinding (0.73 [CI, 0.48 to 1.12]; n = 7), mortality as an end point (1.00 [CI, 0.84 to 1.18]; n = 17), no crossover (1.04 [CI, 0.89 to 1.22]; n = 35), and 100 or more patients (0.94 [CI, 0.77 to 1.14]; n = 10). In trials with two or more such attributes, relative risk was further reduced.Overall, no effect of albumin on mortality was detected; any such effect may therefore be small. This finding supports the safety of albumin. The influence of methodologic quality on relative risk for death suggests the need for further well-designed clinical trials.CONCLUSIONSOverall, no effect of albumin on mortality was detected; any such effect may therefore be small. This finding supports the safety of albumin. The influence of methodologic quality on relative risk for death suggests the need for further well-designed clinical trials.
Author Wilkes, M M
Navickis, R J
Author_xml – sequence: 1
  givenname: M M
  surname: Wilkes
  fullname: Wilkes, M M
  email: mwilkes@hygeiaassociates.com
  organization: Hygeia Associates, 17988 Brewer Road, Grass Valley, CA 95949, USA. mwilkes@hygeiaassociates.com
– sequence: 2
  givenname: R J
  surname: Navickis
  fullname: Navickis, R J
BackLink https://www.ncbi.nlm.nih.gov/pubmed/11487482$$D View this record in MEDLINE/PubMed
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PublicationTitle Annals of internal medicine
PublicationTitleAlternate Ann Intern Med
PublicationYear 2001
References 12204032 - Ann Intern Med. 2002 Sep 3;137(5 Part 1):370-1; author reply 370-1
11730412 - Ann Intern Med. 2001 Dec 4;135(11):1008-9
11829543 - ACP J Club. 2002 Jan-Feb;136(1):2
11487488 - Ann Intern Med. 2001 Aug 7;135(3):205-8
11915791 - Evid Based Nurs. 2002 Jan;5(1):13
References_xml – reference: 11829543 - ACP J Club. 2002 Jan-Feb;136(1):2
– reference: 11487488 - Ann Intern Med. 2001 Aug 7;135(3):205-8
– reference: 12204032 - Ann Intern Med. 2002 Sep 3;137(5 Part 1):370-1; author reply 370-1
– reference: 11915791 - Evid Based Nurs. 2002 Jan;5(1):13
– reference: 11730412 - Ann Intern Med. 2001 Dec 4;135(11):1008-9
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Snippet To test the hypothesis that albumin administration is not associated with excess mortality. Computer searches of the MEDLINE and EMBASE databases, the Cochrane...
To test the hypothesis that albumin administration is not associated with excess mortality.PURPOSETo test the hypothesis that albumin administration is not...
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StartPage 149
SubjectTerms Albumins - administration & dosage
Albumins - therapeutic use
Bias
Colloids - therapeutic use
Critical Care - methods
Critical Illness - mortality
Critical Illness - therapy
Fluid Therapy - methods
Randomized Controlled Trials as Topic
Rehydration Solutions - therapeutic use
Research Design
Risk Factors
Survival Analysis
Title Patient survival after human albumin administration. A meta-analysis of randomized, controlled trials
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