{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T05:06:31Z","timestamp":1789103191258,"version":"build-2803163510"},"reference-count":47,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Med. Sci.","Medical Sciences"],"abstract":"<jats:p>Background\/Objective: Hyperoncotic albumin (20%) has been proposed for sepsis; however, the randomized evidence is inconclusive, and the 2026 Surviving Sepsis Campaign guidelines now suggest crystalloids alone while permitting albumin on a case-by-case basis. We updated the evidence, restricting the intervention to hyperoncotic albumin (\u226520%) and the comparator exclusively to crystalloids, and examined whether the benefit was confined to septic shock. Methods: We searched PubMed, EMBASE, and Cochrane CENTRAL (March 2024\u2013March 2026), supplementing a previously published meta-analysis. Randomized trials of hyperoncotic albumin versus crystalloids in adults with sepsis or septic shock reporting all-cause mortality were included. The primary outcome was mortality at the longest follow-up, pooled as risk ratios (RRs) using random-effects models. Given negligible heterogeneity, the estimate was reported under standard, Hartung\u2013Knapp\u2013Sidik\u2013Jonkman (HKSJ), truncated-HKSJ, and fixed-effects methods, with a Bayesian sensitivity analysis. A pre-specified subgroup contrasted septic shock with sepsis without shock. This review was registered in PROSPERO (CRD420261334243). Results: Eight RCTs (n = 3707) provided the data; all administered 20% albumin. Overall, albumin was not robustly associated with reduced mortality (RR 0.94; I2 = 0%), significant only under the pre-registered HKSJ correction (0.91\u20130.98) but null under the standard, truncated-HKSJ, and fixed-effects models (0.87\u20131.03, p = 0.17), identifying this as a low-heterogeneity artifact. In septic shock (k = 6), the effect was larger and consistent (RR 0.90, 0.82\u20130.99, p = 0.03), with no benefit in sepsis without shock (RR 1.10; interaction p = 0.08). The certainty was low (GRADE). Conclusions: In adults with sepsis, hyperoncotic albumin was not associated with a statistically significant reduction in all-cause mortality, and the certainty of evidence was low (GRADE). This is consistent with the 2026 Surviving Sepsis Campaign guidelines, which permit case-by-case use of albumin in this setting but do not recommend its routine use. Adequately powered randomized trials are required.<\/jats:p>","DOI":"10.3390\/medsci14050550","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T16:30:02Z","timestamp":1788798602000},"page":"550","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hyperoncotic Albumin (20%) Versus Crystalloids for Mortality in Adults with Sepsis and Septic Shock: An Updated Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"14","author":[{"given":"Christian J.","family":"Wiedermann","sequence":"first","affiliation":[{"name":"Institute of General Practice and Public Health, Claudiana\u2014College of Health Professions, 39100 Bolzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianni","family":"Turcato","sequence":"additional","affiliation":[{"name":"Intermediate Care Unit, Department of Internal Medicine, Hospital Alto Vicentino (AULSS-7), 36014 San-torso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arian","family":"Zaboli","sequence":"additional","affiliation":[{"name":"Health Professions Management, South Tyrolean Health Authority (SABES-ASDAA), 39100 Bolzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6996-0881","authenticated-orcid":false,"given":"Michael","family":"Joannidis","sequence":"additional","affiliation":[{"name":"Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"J. 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