(Human albumin administration in critically ill patients: systematic review of randomised controlled trials)
(Excess mortality after human albumin administration in critically ill patients. If it is true what should be do about it?)
Human albumin solution, a blood product, has been used in the treatment of patients with injuries and burns for more than 50 years. Currently albumin is licensed for use in the emergency treatment of shock and burns, and illnesses accompanied by hypoproteinaemia (abnormally low levels of protein in the blood). In this week's BMJ a report by the Cochrane Injuries Group suggests that this practice is likely to have caused thousands of deaths. Consequently the authors call for an urgent review of the use of human albumin solution in critically ill patients.
The Group conducted a review of 30 randomised controlled trials which included over 1400 (1419) patients. They found that overall, the risk of death in patients treated with albumin was six per cent higher than in patients not given albumin. The authors note that their results must be interpreted with caution as they are based on relatively small trials. However, they believe that a reasonable conclusion from their research is that the use of human albumin in the management of critically ill patients should be urgently reviewed.
Contact:
Dr Ian Roberts, Cochrane Injuries Group, Department of Epidemiology and Public Health, Institute of Child Health, London
Francis Tuke, Press Office, Great Ormond Street Children's Hospital
In a linked editorial in this week's BMJ, Dr Martin Offringa, a consultant neonatologist from Emma Children's Hospital in Amsterdam writes that the review by the Cochrane Injuries Group appears to be "scientifically robust" and "albumin administration is [....] harmful in certain categories of patients, (but) favourable effects in particular patients cannot yet be excluded." He stresses that "an effort must be made to identify these patients". The author explains why it may be that albumin supplementation might make things worse for critically ill patients and discusses alternative treatments.
Dr Offringa concludes that "the administration of albumin should be halted until [...] the results of a high quality large clinical trial are available".
Contact:
Dr Martin Offringa, Consultant Neonatologist, Emma Children's Hospital, Academic Medical Centre, Amsterdam, Netherlands