Hemodynamic support in the early phase of septic shock: a review of challenges and unanswered questions

Annals of Intensive Care

Table 2 Systematic reviews and meta-analyses on albumin use as a resuscitation fluid in sepsis/septic shock

Systematic reviews [ref.]	No. of patients (n)	No. of RCTs included (presented)	Intervention fluid therapy	Primary outcome	Results: albumin versus crystalloids	Comments
Bansal et al. [50]	6082	13 (6^†)	Albumin, crystalloids [HES]	Mortality	*OR 0.9 (0.8–1.01)	2 RCTs including children and 1 case mix
				RRT need	?	7 RCTs with specific comparison HES versus crystalloids
Xu et al. [51]	5838	5	Albumin, crystalloids	All-cause mortality	** OR 0.88 (0.76–1.01) p = 0.08 severe sepsis OR 0.81 (0.67–0.97) p = 0.03 Septic shock	4 of 5 RCTs not entirely dedicated to septic patients
Patel et al. [52]	4190	16^†	Albumin, crystalloids	All-cause mortality	RR 0.93 (0.86–1.01) p = 0.07	~ 10 RCTs not entirely dedicated to septic patients
Rochwerg [53]	1238^††	14 (2)	Albumin, crystalloids	All-cause mortality	NMA 0.83 (0.65–1.04) estimate	Only 2 RCTs with direct comparison and one multicentric subgroup analysis encompassing more than 98%

RCT_S randomized control trials, OR odds ratio, RR relative risk, HES hydroxy ethyl starches, NMA nodal meta-analysis
*28- and 30-day mortality
**90-day mortality
^†One EARSS from the reported conference proceedings
^††Post hoc analyses: (1) ALBIOS trial patients (n = 1815) not included because Alb was not used as a resuscitation fluid; data incorporation did not affect the final results, (2) exclusion of data from the one trial encompassing less than 2% of patients did not affect the final results