Human Albumin Infusion in Critically Ill and Perioperative Patients: Narrative Rapid Review of Meta-Analyses from the Last Five Years

Abstract

Background: Human albumin, a vital plasma protein with diverse molecular properties, has garnered interest for its therapeutic potential in various diseases, including critical illnesses. However, the efficacy of albumin infusion in critical care and its associated complications remains controversial. To address this, a review of recent meta-analyses was conducted to summarize the evidence pertaining to albumin use in critical illness. Methods: Adhering to the rapid review approach, designed to provide a concise synthesis of existing evidence within a short timeframe, relevant meta-analyses published in the last five years were identified and analyzed. PubMed, Embase, and Cochrane databases of systematic reviews were searched using pre-defined search terms. Eligible studies included meta-analyses examining the association between albumin infusion and outcomes in critically ill and perioperative patients. Results: Twelve meta-analyses were included in the review, covering diverse critical illnesses and perioperative scenarios such as sepsis, cardiothoracic surgery, and acute brain injury. The analyses revealed varying levels of evidence for the effects of albumin use on different outcomes, ranging from no significant associations to suggestive and convincing. Conclusions: Albumin infusion stabilizes hemodynamic resuscitation endpoints, improves diuretic resistance, and has the potential to prevent hypotensive episodes during mechanical ventilation in hypoalbuminemic patients and improve the survival of patients with septic shock. However, caution is warranted due to the methodological limitations of the included studies. Further high-quality research is needed to validate these findings and inform clinical decision-making regarding albumin use in critical care.

Controversies Surrounding Albumin Use in Sepsis: Lessons from Cirrhosis

“…Albumin is thought to maintain vascular integrity and modulate inflammation in infections. Some studies have pointed to hemodynamic stabilization effects [6], but these have not consistently shown clear clinical benefits. Concerns regarding pulmonary edema and other adverse effects also exist.…”

“…Albumin, a crucial plasma protein, plays key roles in maintaining oncotic pressure, transporting substances, regulating pH, and participating in various physiological processes [1][2][3][4]. Its diverse functions render it vital in clinical settings for managing conditions, such as cirrhosis [5] and critical care [6]. Understanding the various roles of albumin is important, especially in the context of cirrhosis and sepsis.…”

“…The use of albumin in sepsis presents contrasting effects and is controversial. It is considered for volume resuscitation in septic patients because of its plasma volume expansion capability and potential to improve hemodynamic stability [6,11]. Some studies indicate that albumin might be more advantageous than crystalloids, especially in septic shock [12]; however, these benefits have not been consistently confirmed, leading to debates and weak guideline recommendations [11,[13][14][15].…”