Wiedermann Christian J
Institute of General Practice and Public Health, Claudiana-College of Health Professions, 39100 Bolzano, Italy.
Department of Public Health, Medical Decision Making and HTA, University of Health Sciences, Medical Informatics and Technology-Tyrol, 6060 Hall, Austria.
J Clin Med. 2023 Sep 12;12(18):5919. doi: 10.3390/jcm12185919.
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.
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.
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.
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.
人白蛋白是一种具有多种分子特性的重要血浆蛋白，因其在包括危重病在内的各种疾病中的治疗潜力而受到关注。然而，白蛋白输注在重症监护中的疗效及其相关并发症仍存在争议。为解决这一问题，对近期的荟萃分析进行了综述，以总结与危重病中使用白蛋白相关的证据。
采用快速综述方法，旨在在短时间内对现有证据进行简明综合，识别并分析过去五年发表的相关荟萃分析。使用预定义的检索词在PubMed、Embase和Cochrane系统评价数据库中进行检索。符合条件的研究包括检查白蛋白输注与危重病患者及围手术期患者结局之间关联的荟萃分析。
该综述纳入了12项荟萃分析，涵盖了多种危重病和围手术期情况，如脓毒症、心胸外科手术和急性脑损伤。分析显示，白蛋白使用对不同结局的影响证据水平各异，从无显著关联到有提示性和令人信服的关联不等。
白蛋白输注可稳定血流动力学复苏终点，改善利尿剂抵抗，有可能预防低白蛋白血症患者机械通气期间的低血压发作，并提高感染性休克患者的生存率。然而，由于纳入研究的方法学局限性，仍需谨慎。需要进一步的高质量研究来验证这些发现，并为危重病中白蛋白使用的临床决策提供依据。
