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Network meta-analysis of clinical trials of fluid treatments in sepsis demonstrates improved survival with albumin compared with crystalloid and hydroxyethyl starch


Fluid resuscitation is widely practiced in treating sepsis. Comparative assessment of the different fluid modalities is hampered by a paucity of direct trials. We present a network meta-analysis for assessing the relative effectiveness of two fluid treatments in sepsis when they have not been compared directly in a randomized trial but have each been compared with a common treatment.


A systematic review of trials sepsis yielded 13 trials for assessment in network meta-analysis. The indirect comparison between albumin, HES and crystalloid was conducted using Bayesian methods for binomial likelihood, fixed-effects network meta-analysis with a Monte Carlo Gibbs sampling method. Studies in septic patients with crystalloid as a reference treatment compared with any formulation of the colloid treatments albumin or HES were included, as were direct head-to-head trials between the two colloids.


Odds ratios between the different treatments were obtained (Figure 1). Ranking the interventions [1] demonstrated that albumin ranked highest in lowering mortality at a 96.4% probability compared with 3.6% and 0.01% for crystalloid and HES, respectively.


Albumin as a fluid therapy in sepsis is associated with the lowest mortality of the three modalities studied.

Figure 1

Forest plot of results of Bayesian fixed-effect network meta-analysis of mortality.


  1. 1.

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Correspondence to M Bansal.

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Bansal, M., Farrugia, A. & Martin, G. Network meta-analysis of clinical trials of fluid treatments in sepsis demonstrates improved survival with albumin compared with crystalloid and hydroxyethyl starch. Crit Care 17, P375 (2013).

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  • Starch
  • Septic Patient
  • Hydroxyethyl
  • Gibbs Sampling
  • Fluid Resuscitation