Albumin administration in patients with cirrhosis: Current role and novel perspectives

Abstract

Mortality in cirrhosis is mostly associated with the development of clinical decompensation, characterized by ascites, hepatic encephalopathy, variceal bleeding, or jaundice. Therefore, it is important to prevent and manage such complications. Traditionally, the pathophysiology of decompensated cirrhosis was explained by the peripheral arterial vasodilation hypothesis, but it is currently understood that decompensation might also be driven by a systemic inflammatory state (the systemic inflammation hypothesis). Considering its oncotic and nononcotic properties, albumin has been thoroughly evaluated in the prevention and management of several of these decompensating events. There are formal evidence-based recommendations from international medical societies proposing that albumin be administered in individuals with cirrhosis undergoing large-volume paracentesis, patients with spontaneous bacterial peritonitis, those with acute kidney injury (even before the etiological diagnosis), and those with hepatorenal syndrome. Moreover, there are a few randomized controlled trials and meta-analyses suggesting a possible role for albumin infusion in patients with cirrhosis and ascites (long-term albumin administration), individuals with hepatic encephalopathy, and those with acute-on-chronic liver failure undergoing modest-volume paracentesis. Further studies are necessary to elucidate whether albumin administration also benefits patients with cirrhosis and other complications, such as individuals with extraperitoneal infections, those hospitalized with decompensated cirrhosis and hypoalbuminemia, and patients with hyponatremia.

Impact of change in the Naples prognostic score after neoadjuvant chemoradiotherapy on survival in esophageal squamous cell carcinoma patients

“… 9 , 18 - 20 Hypoalbuminemia within NPS indicates systemic inflammation, liver dysfunction, and malnutrition. 21 Additionally, hypocholesterolemia affects cell membrane fluidity, compromising immunocompetent cell function. 22 Furthermore, LMR and NLR, indicative of cancer-associated inflammation and cellular immune response levels, have been associated with cancer development and progression.…”

Establishment and validation of a prognosis nomogram for MIMIC-III patients with liver cirrhosis complicated with hepatic encephalopathy

“…In addition, infusion of more albumin is not completely safe. It is prone to serious adverse events, such as pulmonary edema or fluid overload [ 41 , 42 ], which can even be life-threatening and affect the prognosis. In the future, more relevant clinical trials are needed to validate the efficacy of albumin infusion therapy and the doses used for cirrhosis combined with HE.…”

The influence of structural and functional albumin properties on the life quality in patients with decompensated liver cirrhosis

“…Так, в ходе работы была обнаружена умеренная связь между низкими показателями физической активности, эмоционального функционирования и болевого синдрома с изменениями нативности альбумина (DR), нарушением связывающей (BE), транспортной (RTQ) и детоксикационной функциями (DTE). По-видимому, наличие подобной взаимосвязи является отражением влияния интоксикации и оксидативного стресса, обусловленных снижением способности молекулы альбумина адекватно выполнять свои функции, на соответствующие показатели психологического и функционального комфорта пациента [16][17][18][19][20]. Усиление воспалительных процессов, усугубление явлений системной интоксикации значимо сказываются на снижении качества жизни больного [21][22][23].…”