A systematic review and meta-analysis of seven randomised trials involving 3,273 adults found albumin-based resuscitation associated with a 10% relative reduction in mortality versus crystalloid at the longest follow-up. The confidence interval approached no effect and part of the evidence came from subgroups, leading the authors to rate certainty as low by GRADE.
Key findings
- Seven trials with 3,273 participants were included, but only three primarily recruited septic-shock patients. At follow-up up to 90 days, mortality RR was 0.90 (95% CI 0.83-0.99; p=0.02; I²=0%). Bayesian analysis estimated a 94.7% posterior probability that RR was below 1. No clear effect modification emerged by formulation, dosing strategy or baseline albumin.
Why this matters globally
Fluid choice in septic shock affects many patients and health-system costs. Confirmation could influence practice, but absolute benefit, cost, adverse events and responsive subgroups require dedicated, adequately powered RCTs.
Thai researcher contribution
Marcus J. Schultz listed Mahidol University among his affiliations and contributed to the international evidence-synthesis team. The Thai link is collaborative authorship; it does not mean the underlying trials were conducted in Thailand.
Limitations to consider
Only three trials primarily enrolled septic-shock patients; the rest contributed subgroup or stratum data, creating indirectness. The CI was close to 1, and the pooled estimate does not define individual absolute benefit. GRADE certainty was low, subgroup power was limited, and meta-analysis cannot replace a dedicated trial.