Twenty-five RCTs were included (n=1,485). These included 21 parallel-group and four cross-over RCTs. Blinding was used in four RCTs and allocation concealment was adequate in four RCTs.
Surgery (five RCTs): Hyperoncotic albumin was associated with better preservation of renal function compared with hydroxyethyl starch (one study) and reduced intestinal oedema compared with hydroxyethyl starch and crystalloid (one study).
Trauma (five RCTs, all conducted by the same researcher): Three studies reported no apparent benefits for hyperoncotic albumin compared with hydroxyethyl starch. Two studies reported that hydroxyethyl starch was associated with increased cardiac index and oxygenation.
Sepsis (seven RCTs, including six by the same researcher): Hydroxyethyl starch was associated with a higher cardiac index and oxygenation than hyperoncotic albumin (three studies).
Liver disease (three RCTs): Hyperoncotic albumin was associated with an improved treatment response and renal function and shorter hospital stay in patients with refractory ascites (one study).
High-risk neonates (three RCTs): Hyperoncotic albumin was associated with a reduction in illness frequency, improved respiratory function and less whole-body oedema in high-risk premature infants (two studies) and higher Apgar scores, lower risk of cerebral oedema and shorter hospital stay in newborns with asphyxia (one study).
Brain injury (two RCTs): Hyperoncotic albumin was associated with a reduction in disability in patients with acute ischaemic stroke (one study) and more favourable neurological outcomes in patients with closed head injury (one study).
Intradialytic hypotension (two cross-over RCTs): Hyperoncotic albumin was associated with a greater avoidance of blood volume reduction than saline (one study) or hypertonic saline (one study).
Nephrotic syndrome (three RCTs): Hyperoncotic albumin in combination with furosemide was associated with an accelerated diuresis and increased weight loss (one study) and aiding the diuretic and naturetic effects of furosemide (one study).
Survival: There was no statistically significant difference in survival between hyperoncotic albumin and control regimens, RR 0.95 (95% CI: 0.78, 1.17; 20 RCTs). No significant heterogeneity was found (p=0.86). Egger’s test showed no evidence of publication bias (p=0.87). The analysis had a 98 per cent power of detecting a 35 per cent reduction in RR of mortality and an 82 per cent power of detecting a 35 per cent increase in RR of mortality.
Other results were reported.