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Objective <p>To determine the effect of albumin-based fluid resuscitation on mortality in adults with septic shock.</p> Design <p>Systematic review and dual frequentist–Bayesian meta-analysis of randomised clinical trials (RCTs), following PRISMA guidelines and preregistered protocol (CRD420261325998).</p> Data sources <p>PubMed, Embase, CENTRAL, and Scopus were searched from inception to February 2026.</p> Methods <p>Eligible RCTs comparing albumin-based resuscitation strategies versus crystalloid-based resuscitation in adults with septic shock were included. The primary outcome was all-cause mortality at the longest available follow-up (up to 90 days). The analysis utilised random-effects models, subgroup analyses, and Bayesian methods.</p> Results <p>Seven trials (<i>n</i> = 3273) were included. Three trials primarily recruited septic shock patients, while data from the remaining were derived from subgroups or extracted strata. At the longest available follow-up, albumin-based fluid resuscitation was associated with a statistically significant 10% reduction in the relative risk of all-cause mortality (RR 0.90, 95% CI 0.83–0.99; <i>p</i> = 0.02; I² = 0%). Bayesian analysis under the primary weakly informative prior yielded a posterior probability of mortality reduction of 94.7% (P[RR &lt; 1.0]). Pre-specified subgroup analyses by albumin formulation, dosing strategy, and trial-level baseline serum albumin did not show evidence of effect modification.</p> Conclusion <p>In adults with septic shock, albumin-based resuscitation strategies are associated with a statistically significant reduction in mortality at the longest available follow-up, with a directionally concordant Bayesian estimate. A mortality benefit is therefore plausible, but the supporting evidence is indirect and imprecise (GRADE: low certainty). Adequately powered trials specifically addressing albumin fluid resuscitation in septic shock are warranted.</p>

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Mortality effect of albumin fluid resuscitation in adults with septic shock: a systematic review and dual frequentist–bayesian meta-analysis of randomised trials

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月6日

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  • Henrique Mendes,
  • Henry Kinkei Wen,
  • Harry de Souza,
  • Yuanyuan Peng,
  • Kush Deshpande,
  • Siebe G. Blok,
  • Pieter R. Tuinman,
  • Ary Serpa Neto,
  • Marcus J. Schultz,
  • Manu L. N. G. Malbrain,
  • Giacomo Grasselli,
  • Frank M. P. van Haren

摘要

Objective

To determine the effect of albumin-based fluid resuscitation on mortality in adults with septic shock.

Design

Systematic review and dual frequentist–Bayesian meta-analysis of randomised clinical trials (RCTs), following PRISMA guidelines and preregistered protocol (CRD420261325998).

Data sources

PubMed, Embase, CENTRAL, and Scopus were searched from inception to February 2026.

Methods

Eligible RCTs comparing albumin-based resuscitation strategies versus crystalloid-based resuscitation in adults with septic shock were included. The primary outcome was all-cause mortality at the longest available follow-up (up to 90 days). The analysis utilised random-effects models, subgroup analyses, and Bayesian methods.

Results

Seven trials (n = 3273) were included. Three trials primarily recruited septic shock patients, while data from the remaining were derived from subgroups or extracted strata. At the longest available follow-up, albumin-based fluid resuscitation was associated with a statistically significant 10% reduction in the relative risk of all-cause mortality (RR 0.90, 95% CI 0.83–0.99; p = 0.02; I² = 0%). Bayesian analysis under the primary weakly informative prior yielded a posterior probability of mortality reduction of 94.7% (P[RR < 1.0]). Pre-specified subgroup analyses by albumin formulation, dosing strategy, and trial-level baseline serum albumin did not show evidence of effect modification.

Conclusion

In adults with septic shock, albumin-based resuscitation strategies are associated with a statistically significant reduction in mortality at the longest available follow-up, with a directionally concordant Bayesian estimate. A mortality benefit is therefore plausible, but the supporting evidence is indirect and imprecise (GRADE: low certainty). Adequately powered trials specifically addressing albumin fluid resuscitation in septic shock are warranted.