Albumin administration in patients with decompensated liver cirrhosis: a meta-analytic update

Abstract

End-stage liver disease and its related complications exert a huge disease burden and reduce the survival rates of many patients. Albumin administration for patients with decompensated liver cirrhosis has been a controversial topic of discussion. The aim of this study is to investigate whether albumin reduces the mortality and complications of liver cirrhosis compared to standard medical therapy (SMT) alone. Clinical trials in which albumin administration was compared to SMT in patients with liver cirrhosis were included in this meta-analysis. The primary outcome of this study was to evaluate the effect on reducing all-cause mortality. Ascites control, renal failure and hepatic encephalopathy were evaluated as secondary outcomes. Nine clinical trials with 1231 patients were recruited and analyzed using the quality effect model. Mortality rate was significantly reduced in the albumin group [relative risk (RR) 0.73, 95% confidence interval (CI) 0.56–0.96]. Heterogeneity was mild across all studies (I2 23.3%). Studies reporting long-term albumin (LTA) administration were found to have a significant decrease in mortality (RR 0.57, 95% CI 0.44–0.73). However, studies reporting short-term albumin administration were found to have no effect on mortality (RR 0.90, 95% CI 0.56–1.45). Furthermore, there was a significant decrease in the incidence of all secondary outcomes. This meta-analysis provides evidence that LTA administration is significantly effective in reducing the mortality of liver cirrhosis compared to SMT. Albumin administration was also shown to reduce the occurrence of ascites, renal failure and hepatic encephalopathy as complications of liver cirrhosis.

Therapeutic effect of autologous bone marrow cells injected into the liver under the guidance of B‑ultrasound in the treatment of HBV‑related decompensated liver cirrhosis

“…Hepatocyte-protecting drugs such as glutathione, ganning tablets, silymarin, inosine and vitamins C, E and B groups can improve liver cell metabolism, prevent fatty degeneration and protect liver cells (22). For hypoalbuminemia and ascites, although treatments such as ALB infusion and diuretics have a certain curative effect, they cannot solve the fundamental problem of DLC, thus DLC gradually leads to liver failure (23,24). The present study revealed that the routine drug treatment for DLC, which was administered for 1 year, led to no significant changes in liver function and blood indexes.…”

Can albumin reduce the mortality of patients with cirrhosis and ascites? A meta-analysis of randomized controlled trials

“…The introduction of albumin administration in the 1960s provided new ideas for treating liver cirrhosis, but whether albumin administration affects the mortality and complication rate of patients with chronic liver cirrhosis has been controversial. Some reviews have pointed out that albumin can reduce the incidence of volume overload and inflammation, thus significantly reducing the mortality of patients with liver cirrhosis, and albumin administration can also reduce the incidence of such liver cirrhosis complications as ascites, renal failure, and hepatic encephalopathy [11]. Others have expressed the opposite view, arguing that there is no evidence that long-term administration of albumin has a significant survival benefit on mortality or other complications of liver cirrhosis [12].…”

“…However, contradictory results were shown in some clinical trial studies. Two previous foreign meta-analyses also explored whether albumin infusion was conducive to reducing the mortality of liver cirrhosis and the risk of relative complications, but the results were divergent [11,12]. In addition, the duration of albumin treatment for decompensated liver cirrhosis is unclear.…”

Management of Hepatic Encephalopathy Associated with Advanced Liver Disease

“…Some of these treatments, such as rifaximin and probiotics, in addition to acting through the ammonia pathway, also may act on inflammation. Albumin, a protein with anti-inflammatory, antioxidant and immunomodulatory properties [ 65 ], has shown some improvement in survival and clinical symptoms of HE, but these results need to be confirmed in future studies [ 66 ].…”