Skip to main content

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

Introduction

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.

Methods

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.

Results

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.

Conclusion

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

Figure 1
figure1

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

References

  1. 1.

    Salanti G, Ades AE, Ioannidis JP: Graphical Methods and numerical summaries for presenting Results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol 2011, 64: 163-171. 10.1016/j.jclinepi.2010.03.016

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to M Bansal.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

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). https://doi.org/10.1186/cc12313

Download citation

Keywords

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