Hyper-oncotic albumin administration reduces mortality in acute Respiratory Distress Syndrome compared to crystalloid: a systematic review and meta-analysis.

Yan-Jie Zhang; Zhu Luo; Zhen Wang; Ji-Yue Shao; Jingyuan Xu

doi:10.1080/07853890.2026.2637271

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Hyper-oncotic albumin administration reduces mortality in acute Respiratory Distress Syndrome compared to crystalloid: a systematic review and meta-analysis.

Yan-Jie Zhang·Zhu Luo·Zhen Wang·Ji-Yue Shao·Jingyuan Xu

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Abstract

BACKGROUND: To evaluate the association between albumin administration as volume replacement and mortality in adult ARDS patients, we performed this meta-analysis and trial sequential analysis (TSA). METHODS: We searched databases including PubMed, Science Direct, Scopus, Web of Science databases and Cochrane Central Register of Controlled Trials up to 12 December 2024. We screened trials that included adult ARDS patients and compared albumin with crystalloid. The 28-day mortality served as the primary endpoint, while the oxygenation change, the length of ICU stay and the length of hospital stay were designated as secondary outcomes. To clarify the differing concentrations of albumin, we formed two distinct subgroups: the hyper-oncotic albumin subgroup (≥20%) and the iso-oncotic albumin subgroup (4%∼5%). Statistical synthesis was performed with Cochrane Review Manager 5.4.1, employing random-effects models. To mitigate random errors, TSA was implemented with α = 0.05 and β = 0.20 parameters. RESULTS: The analysis incorporated 5 publications: 3 randomized controlled trials (RCTs) and 2 non-randomized studies (NRSs). Overall mortality was lower in the albumin group (33.2%, 97/292) than in the crystalloid group (44.9%, 133/296) (OR = 0.61, 95%CI 0.43-0.85, p = 0.004). RCTs (n = 204) showed no benefit (OR = 0.83, p = 0.54), but NRSs (n = 384) demonstrated reduced mortality (OR = 0.52, p = 0.002). Hyper-oncotic albumin was associated with lower mortality in NRSs (OR = 0.40, p = 0.02) but not in RCTs (OR = 0.74, p = 0.57). Iso-oncotic albumin showed no benefit (OR = 0.88, p = 0.72). Regarding the impact of albumin on oxygenation, significant improvements in oxygenation were observed only on the first (p = 0.05) and second days (p < 0.0001). The TSA indicated a continued need for high-quality RCTs. CONCLUSIONS: Our analysis suggests that hyper-oncotic albumin may reduce mortality and improve early oxygenation in ARDS patients compared to crystalloids. Larger RCTs are urgently needed to validate these findings and define their potential role in clinical management.

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Humans Crystalloid Solutions Respiratory Distress Syndrome Albumins Length of Stay Randomized Controlled Trials as Topic Fluid Therapy Intensive Care Units Acute Respiratory Distress Syndrome (ARDS)albumin fluid management hyper-oncotic albumin mortality Journal Article Systematic Review Meta-Analysis Comparative Study Research Support, Non-U.S. Gov't

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Yan-Jie Zhang, Zhu Luo, Zhen Wang, Ji-Yue Shao, Jingyuan Xu. 2026-03-24. Hyper-oncotic albumin administration reduces mortality in acute Respiratory Distress Syndrome compared to crystalloid: a systematic review and meta-analysis.. https://doi.org/10.1080/07853890.2026.2637271

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Comparative Study subject Fluid Therapy subject Humans subject Intensive Care Units subject Journal Article subject Length of Stay subject Meta-Analysis subject Mortality subject Systematic reviews study

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