The impact of albumin infusion on the risk of rebleeding and in-hospital mortality in cirrhotic patients admitted for acute gastrointestinal bleeding: a retrospective study of a single institute

Wang, Zhu; Xie, Ya-Wen; Lü, Qing; Yan, Hai-Lin; Liu, Xinbin; Liu, Yi; Zhang, Xian; Yang, Jinlin

doi:10.1186/s12876-020-01337-5

Cited by 16 publications

(8 citation statements)

References 23 publications

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“…Hypoalbuminemia is considered an indicator of the severity of liver dysfunction 33 . Wang et al 34 found that albumin infusion can reduce the risk of recurrent bleeding and hospital death in patients with cirrhosis and EGVB. Univariate analysis in this study suggested that albumin was a protective factor for recurrent bleeding (0.895).…”

Section: Discussionmentioning

confidence: 99%

The prognostic evaluation of ALBI score in endoscopic treatment of esophagogastric varices hemorrhage in liver cirrhosis

Liu,

Wu,

Cai

et al. 2024

Sci Rep

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To analyze the independent risk factors for recurrent bleeding and death within 1 year after endoscopic treatment of esophagogastric varices hemorrhage (EGVB) in patients with liver cirrhosis, and to validate the predictive value of ALBI score for recurrent bleeding and death within 1 year after endoscopic treatment of EGVB in patients with liver cirrhosis. A total of 338 patients with EGVB who received endoscopic treatment for the first time in the Department of Gastroenterology, First Affiliated Hospital of Nanchang University from January 1, 2016 to March 1, 2020 were selected. A database was established to analyze the patients’ demographic data, surgical variables and postoperative outcomes. All patients were contacted and followed up to verify the predictive value of ALBI score for recurrent bleeding and mortality. 130 patients had rebleeding within 1 year after surgery (38.5%). 66 patients died within 1 year after surgery (19.5%). Patients with ALBI grade 3 had significantly higher rebleeding and mortality rates than those with grades 1 and 2. The AUC was used to compare the predictive value of the four scores for rebleeding and mortality within one year after endoscopic surgery. Both ALBI scores had the largest AUC. The ALBI score has certain predictive value for rebleeding and mortality within 1 year after endoscopic therapy in patients with cirrhotic EGVB.

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Section: Discussionmentioning

confidence: 99%

The prognostic evaluation of ALBI score in endoscopic treatment of esophagogastric varices hemorrhage in liver cirrhosis

Liu,

Wu,

Cai

et al. 2024

Sci Rep

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“… 43 This probably is due to improved hemodynamics and GFR, especially in those achieving higher serum albumin (4g/dl) as shown in the post hoc analysis. Our choice of targeting serum albumin level to 4 g/dl was based on previous experience in our unit where in-patients having a serum albumin level at or above 4 g/dl had better survival (unpublished observation), a fact supported by post hoc analysis of ANSWER trial and by Wang et al 44 Similar to our study, Terlipressin with albumin was reported to be better in reversing HRS, as compared to Placebo with albumin, with a presumed beneficial effect in reducing portal pressure and consequently decreased gut congestion, endotoxemia, and reduced pro-inflammatory cytokines. 45 The merit of our study is that we have demonstrated the benefit of response-guided SAFI±T/NAdr therapy on survival through improved hemodynamics, cytokines, and Netosis ( Figure 3 ).…”

Section: Discussionmentioning

confidence: 99%

Response Guided Slow Infusion of Albumin, Vasoconstrictors and Furosemide Improves Ascites Mobilization and Survival in Acute on Chronic Liver Failure: A Proof-of-Concept Study

Pande¹,

Hatti²,

Kumar³

et al. 2022

JIR

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Background and Aims Acute-on-chronic liver failure (ACLF) with increasing organ failure is associated with poor outcomes. Severely deranged systemic hemodynamics and decreased effective arterial blood volume contribute to tissue damage and organ failure. Response-guided therapy with albumin, vasoconstrictors, and furosemide may help overcome effective hypovolemia, improve diuresis and impact survival. Methods In the observation cohort, 230 patients with ACLF (CANONIC criteria) with ascites (≥Grade II) and ACLF ≥Grade I were enrolled. A total of 136 patients (GROUP I) received response-guided (urine sodium >80mmol/day) slow albumin-furosemide infusion ± terlipressin (SAFI ± T), while 94 patients (GROUP II) received standard medical therapy. Twenty-eight-day survival, ascites mobilization (nil or grade 1), and adverse events were noted. In another mechanistic cohort (n = 40), laboratory evidences for improvement in various pathophysiological alterations; gut permeability, endotoxemia, cytokine storm, neutrophil dysfunction, and hemodynamic alterations following SAFI ± T/Noradrenaline (NAdr) were evaluated. Results Age, gender, CLIF-C-ACLF, SOFA and MELD scores, ACLF grades and urine sodium were not different between the two groups in the observation cohort. Ascites was mobilized in 102/136 in GROUP I (SAFI ± T) and 23/94 in GROUP II (p < 0.05). Twenty-eight-day survival was significantly higher in GROUP I = 103/136 (75.7%) vs GROUP II = 50/94 (53.2%), (P = <0.001). All those who were unable to reach urine sodium >80 mmol/day died. Four patients in GROUP I developed scrotal gangrene. In the mechanistic cohort, 72% of patients survived with significant improvement in gut permeability, endotoxemia, serum cytokines, neutrophil dysfunction, and hemodynamic alterations. Conclusion Ascitic fluid mobilization by response-guided SAFI ± T/NAdr therapy improves survival by improving splanchnic and systemic hemodynamics, decreasing gut congestion, gut permeability, and endotoxemia, improving neutrophil functions, and reducing pro-inflammatory cytokines in circulation.

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“…Zhou et al [32]conducted a multicenter retrospective study and found that the albumin concentration > 31.5 g/L was a protective factor for early rebleeding after EVL. A retrospective study by Wang et al [33]showed that in patients with hypoalbuminemia, albumin infusion can reduce the risk of in-hospital rebleeding, and in patients with Child-Pugh class C, albumin infusion can reduce the number of in-hospital deaths. The results in this study also showed that rebleeding after EVL may be related to a low albumin level.…”

Section: Construction Of the Nomogram Prediction Modelmentioning

confidence: 99%

The impact of restrictive blood transfusion on the safety of patients with esophageal varices after endoscopic variceal ligation

Chen,

Ming,

Chen

et al. 2023

Preprint

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Background: To study the effect of restrictive blood transfusion on the safety of early rebleeding after endoscopic variceal ligation(EVL) in patients with liver cirrhosis. Methods:The patients with cirrhosis and esophageal varices who underwent endoscopic variceal ligation at the Affiliated Hospital of North Sichuan Medical College from September 2021 to March 2023 were collected. The clinical data such as serum albumin level, hemoglobin level, liver function classification and the incidence of early rebleeding were recorded. The patients were divided into restrictive red blood cell transfusion group and non transfusion group according to whether there was red blood cell transfusion during hospitalization. The influence of restrictive transfusion and non transfusion group on the postoperative safety of endoscopic variceal ligation was observed. Results:A total of 246 cirrhotic patients were included in the analysis. There were significant differences in hemoglobin level, liver function classification, early rebleeding rate, hospitalization days, and hospitalization expenses between the restrictive transfusion and the non transfusion groups. The early rebleeding rate was significantly different between the groups with different hemoglobin levels after operation. Multivariate logistic analysis showed that postoperative hemoglobin level(OR=0.964, 95%CI: 0.956–0.971; P<0.001) and preoperative albumin level(OR=0.910, 95%CI: 0.892–0.929; P<0.001) were independent influencing factors of early rebleeding. Conclusions:The higher the hemoglobin level of cirrhotic patients with esophageal varices after endoscopic variceal ligation, the lower the incidence of early rebleeding, and restrictive blood transfusion appeared to increase the risk of early rebleeding, which needs be further confirmed in future research.

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The impact of albumin infusion on the risk of rebleeding and in-hospital mortality in cirrhotic patients admitted for acute gastrointestinal bleeding: a retrospective study of a single institute

Cited by 16 publications

References 23 publications

The prognostic evaluation of ALBI score in endoscopic treatment of esophagogastric varices hemorrhage in liver cirrhosis

The prognostic evaluation of ALBI score in endoscopic treatment of esophagogastric varices hemorrhage in liver cirrhosis

Response Guided Slow Infusion of Albumin, Vasoconstrictors and Furosemide Improves Ascites Mobilization and Survival in Acute on Chronic Liver Failure: A Proof-of-Concept Study

The impact of restrictive blood transfusion on the safety of patients with esophageal varices after endoscopic variceal ligation

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