Albumin Does Not Confer Mortality Benefit in Patients with Sepsis

March 18, 2014

Albumin Does Not Confer Mortality Benefit in Patients with Sepsis

  1. Ali S. Raja, MD, MBA, MPH, FACEP

Compared with standard crystalloid therapy, adding albumin did not improve outcomes in patients with severe sepsis or septic shock.

  1. Ali S. Raja, MD, MBA, MPH, FACEP

Maintenance of blood pressure for tissue perfusion is a cornerstone of sepsis treatment, and albumin plays a significant role in maintaining plasma oncotic pressure. A prior randomized trial demonstrated a trend toward lower mortality in a subgroup of intensive care unit (ICU) patients with sepsis treated with 4% albumin versus saline (NEJM Journal Watch Cardiol Jul 23 2004). In the current multicenter study, investigators in Italy randomized 1818 ICU patients with severe sepsis to treatment with either crystalloid alone or crystalloid and 20% albumin. Albumin was administered daily to a serum albumin target of 3 g/dL or more.

The albumin group did not have improved mortality outcomes compared with the crystalloid group: 28-day mortality was 32% in both groups; 90-day mortality was 41% and 44%, respectively. Similarly, secondary outcomes of end-organ dysfunction and ICU length of stay did not differ significantly between groups.


Albumin should not routinely be added to standard crystalloid infusions for patients with severe sepsis or septic shock, as it does not confer a mortality benefit. This study should not change current practice. Although the authors note that a post-hoc subgroup analysis of patients with septic shock demonstrated a mortality benefit with albumin, even this benefit did not remain after they controlled for clinically relevant variables.

Editor Disclosures at Time of Publication

  • Disclosures for Ali S. Raja, MD, MBA, MPH, FACEP at time of publication Consultant / Advisory board Diagnotion, LLC Speaker's bureau Airway Management Education Center Grant / research support NHLBI; Brigham and Women’s Hospital Eleanor and Miles Shore Award; Harvard Medical School Milton Foundation; DHHS/CMS; NIBIB Editorial boards Western Journal of Emergency Medicine Leadership positions in professional societies Society for Academic Emergency Medicine; Brigham and Women’s Physician Organization


Reader Comments (2)

David Skewes Other Healthcare Professional, Anesthesiology, Peter MacCallum Cancer Centre, Melbourne, Australia

4% albumin acts as a hypotonic solution; it's hardly surprising it has no benefit. Look up Neil Soni's work in the late 80's using labelled albumin; it spreads throughout all compartments.Why do we need to keep reinventing the wheel?

Alonso Gutierrez, MD Resident, Internal Medicine, Fundacion clinica medica sur

Medicina basada en la evidencia contundente

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