Excess mortality after human albumin administration in critically ill patients

Abstract

Albumin is a medium weight colloid which plays an essential role in generating the colloid-osmotic pressure. It facilitates fluid retention in the intravascular space. Human albumin is often given to critically ill patients with life threatening hypovolaemia. Low serum albumin concentrations are seen in various disease states and may be due to leakage, increased metabolism, or insufficient synthesis in the liver. The serum albumin concentration in critically ill patients seems to be inversely related to mortality.1 Yet does this observation imply that hypoalbuminaemia should be treated with albumin? In this week's issue a systematic review—published simultaneously in the Cochrane Library2 and a sequel to a paper on the controversy of whether critically ill patients with hypovolaemia should be given colloid or crystalloid fluids3—evaluates the use of human albumin in various clinical settings (p 235).4