Safety of human albumin-serious adverse events reported worldwide in 1998-2000( dagger ).

Vincent JL, Wilkes MM, Navickis RJ.
Br J Anaesth. 2003 Nov;91(5):625-30.

Department of Intensive Care, Hopital Erasme, Universite Libre de Bruxelles, Route de Lennik 808,B-1070 Brussels, Belgium. Hygeia Associates, Grass Valley, California, USA.

BACKGROUND: Previous pharmacovigilance studies have indicated a low rate of adverse events in patients receiving human albumin. However, the incidence of adverse events is likely to have been underestimated because of under-reporting. A more accurate estimate may be possible during a period such as 1998-2000, when awareness regarding albumin safety was heightened by publication of a meta-analysis. METHODS: All serious adverse event reports received, and total doses of albumin distributed worldwide from the beginning of 1998 to the end of 2000 by 10 major suppliers of therapeutic human albumin were compiled. RESULTS: Distributed albumin doses totalled 1.62 x 10(7). The total numbers of non-fatal and fatal serious adverse events reported were 198 and 13, respectively. The incidence of all reported serious non-fatal and fatal adverse events was 5.28 per 10(6) doses (CI 1.60-17.4 per 10(6) doses). For non-fatal serious adverse events only, the observed incidence was 4.65 per 10(6) doses (CI 1.34-16.2 per 10(6) doses). No patient death was classified as probably related to albumin administration. The observed incidence of fatal serious adverse events possibly related to albumin was 0.185 per 10(6) doses (CI 0.0597-0.574 per 10(6) doses). The observed incidence of all non-fatal and fatal serious adverse events was significantly higher during the 1998-2000 period as compared with 1990-1997 (incidence rate ratio 4.98; CI 3.94-6.29), probably chiefly as a result of reduced under-reporting. CONCLUSIONS: Although the observed incidence of adverse events is likely to be an underestimate, nevertheless both non-fatal and fatal serious adverse events in albumin recipients appear to be rare. These results add further support to the excellent safety record of human albumin. Br J Anaesth 2003; 91: 625-30