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Patient Survival after Human Albumin Administration: A Meta-Analysis of Randomized, Controlled Trials

Mahlon M. Wilkes, PhD; and Roberta J. Navickis, PhD
[+] Article and Author Information

From Hygeia Associates, Grass Valley, California.


Grant Support: By the Plasma Protein Therapeutics Association and the American Red Cross.

Requests for Single Reprints: Mahlon M. Wilkes, PhD, Hygeia Associates, 17988 Brewer Road, Grass Valley, CA 95949; e-mail, mwilkes@hygeiaassociates.com.

Current Author Addresses: Drs. Wilkes and Navickis: Hygeia Associates, 17988 Brewer Road, Grass Valley, CA 95949.

Author Contributions: Conception and design: M.M. Wilkes, R.J. Navickis.

Analysis and interpretation of the data: M.M. Wilkes, R.J. Navickis.

Drafting of the article: M.M. Wilkes, R.J. Navickis.

Critical revision of the article for important intellectual content: M.M. Wilkes, R.J. Navickis.

Final approval of the article: M.M. Wilkes, R.J. Navickis.

Statistical expertise: M.M. Wilkes.

Obtaining of funding: M.M. Wilkes, R.J. Navickis.

Administrative, technical, or logistic support: M.M. Wilkes, R.J. Navickis.

Collection and assembly of data: M.M. Wilkes, R.J. Navickis.


Ann Intern Med. 2001;135(3):149-164. doi:10.7326/0003-4819-135-3-200108070-00007
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Albumin administration has played a part in fluid management of acutely ill patients for more than 50 years (1). Indications for which albumin therapy is licensed in the United States include hypovolemia or shock; burns; hypoalbuminemia or hypoproteinemia; surgery; trauma; cardiopulmonary bypass; the acute respiratory distress syndrome; hemodialysis; acute nephrosis; hyperbilirubinemia; acute liver failure; ascites; and sequestration of protein-rich fluids in acute peritonitis, pancreatitis, mediastinitis, and extensive cellulitis (26). Albumin therapy has multiple effects, including volume expansion (78), increased serum albumin concentration (9) and colloid osmotic pressure (10), and hemodilution (8). Albumin may be used expressly to achieve one or more of these effects. For instance, in high-risk neonates, albumin therapy may be given to expand intravascular volume and correct hypoalbuminemia (11). Both volume expansion and hemodilution may be desired in cardiopulmonary bypass surgery (1213) and acute ischemic stroke (14).

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albumins

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Figure 1.
Number of trials evaluated at each stage of the meta-analysis.
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Figure 2.
Mortality and relative risk in individual trials and pooled relative risk under a fixed-effects model.

The relative risk for individual trials is shown as boxes scaled according to weighting by using the inverse variance method. Error bars indicate 95% CIs. The pooled relative risk estimates are shown as diamonds that span the 95% CI.

Grahic Jump Location

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Summary for Patients

Whether Albumin Therapy Improves or Worsens Survival of Critically Ill Patients Is Not Known

The summary below is from the full report titled, “Patient Survival after Human Albumin Administration. A Meta-Analysis of Randomized, Controlled Trials.” It is in the 7 August 2001 issue of Annals of Internal Medicine (volume 135, pages 149-164). The authors are MM Wilkes and RJ Navickis.

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