2021
DOI: 10.1056/nejmoa2022166 View full text |Buy / Rent full text
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Abstract: BACKGROUNDInfection and increased systemic inflammation cause organ dysfunction and death in patients with decompensated cirrhosis. Preclinical studies provide support for an antiinflammatory role of albumin, but confirmatory large-scale clinical trials are lacking. Whether targeting a serum albumin level of 30 g per liter or greater in these patients with repeated daily infusions of 20% human albumin solution, as compared with standard care, would reduce the incidences of infection, kidney dysfunction, and de… Show more

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“…Furthermore, the INFECIR-1/-2 an ALB-CIRINF trials (investigating the use of albumin in patients with ACLD and non-SBP bacterial infections) found no significant impact on kidney dysfunction 83 85 . Moreover, the ALB-CIRINF study and the ATTIRE trial reported increased occurrence of pulmonary edema (putatively associated with volume overload) in the albumin groups, indicating that the indiscriminate short-term use of albumin not only may lack therapeutic benefit but also may lead to adverse events 82 , 83 .…”
Section: Managementmentioning
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“…Furthermore, the INFECIR-1/-2 an ALB-CIRINF trials (investigating the use of albumin in patients with ACLD and non-SBP bacterial infections) found no significant impact on kidney dysfunction 83 85 . Moreover, the ALB-CIRINF study and the ATTIRE trial reported increased occurrence of pulmonary edema (putatively associated with volume overload) in the albumin groups, indicating that the indiscriminate short-term use of albumin not only may lack therapeutic benefit but also may lead to adverse events 82 , 83 .…”
Section: Managementmentioning
“…In contrast, the results from the ATTIRE RCT (14 days of albumin treatment to achieve serum albumin levels of at least 35 g/L vs. standard care in patients with AD and serum albumin levels of less than 30 g/L) were recently published and indicated no beneficial effect of albumin on the primary endpoint (composite of infection, renal dysfunction, or mortality between days 3 and 15 after treatment) 82 . Furthermore, the INFECIR-1/-2 an ALB-CIRINF trials (investigating the use of albumin in patients with ACLD and non-SBP bacterial infections) found no significant impact on kidney dysfunction 83 85 .…”
Section: Managementmentioning
“…Albumin infusion was recently investigated in a randomized, multicenter, open-label trial involving 777 patients hospitalized with decompensated cirrhosis [35]. On admission, patients had serum albumin <3 g/dl.…”
Section: Human Albuminmentioning
“…25% albumin is commonly given after large-volume paracentesis at a dose of 5-10 g per liter removed [ 34 ]. Albumin infusion was recently investigated in a randomized, multicenter, open-label trial involving 777 patients hospitalized with decompensated cirrhosis [ 35 ]. On admission, patients had serum albumin <3 g/dl.…”
Section: Reviewmentioning
“…A large multicentre randomized trial published since the clinical practice guidelines evaluated hyperoncotic albumin versus standard care in hospitalized patients with complications associated with decompensated cirrhosis and serum albumin concentrations less than 3 g/dl within 72 h after admission 17 . Patients in the trial (known as ATTIRE) were randomized to receive 20% albumin by continuous infusion to a targeted serum albumin concentration of 3.5 g/dl in order to help insure that the actual concentrations obtained were at least 3.0 g/dl.…”
Section: Commentmentioning