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

Abstract

Background Albumin therapy in patients with decompensated liver cirrhosis has always been a controversial issue. This study aimed to investigate the efficacy and safety of albumin in reducing mortality and controlling complications in patients with liver cirrhosis and provide a reference for relevant decision-making. Methods Databases such as PubMed, EMBASE, and Web of Science were searched to collect eligible articles published before January 2022, which were analyzed by Revman 5.3. Results A total of 10 randomized controlled trials (2040 patients) were included. Based on the meta-analysis results, no significant difference in mortality was shown between the albumin administration group and the control group (HR = 1.01; 95% CI, 0.97–1.05; P = 0.62). Subgroup analysis showed that albumin administration had no significant short-term or long-term survival benefits in patients with decompensated liver cirrhosis and increased the risk of pulmonary edema adverse reactions (RR = 3.14; 95% CI, 1.48–6.65; P = 0.003). Subgroup analysis based on albumin administration time showed that short-term (HR = 0.93; 95% CI, 0.76–1.13; P = 0.47) or long-term (HR = 0.97; 95% CI: 0.87–1.08; P = 0.58) administration of albumin could not significantly reduce the mortality of patients with decompensated liver cirrhosis. In contrast, albumin administration could significantly reduce the recurrence rate of ascites (RR = 0.56; 95% CI, 0.46–0.68; P = 0.000). Conclusion Short-term(<1 month) or long-term (>1 month) administration of albumin can not significantly reduce the mortality of patients with decompensated liver cirrhosis, and a large amount of albumin infusion will increase the risk of pulmonary edema.

Clinical Characteristics and Risk Factors for Infection and Death in Critically Ill Patients with Pulmonary Infection with Elizabethkingia Spp.

“… 40 Reduced serum albumin levels are strongly associated with mortality in patients with cardiovascular disease, heart failure, and cirrhosis. 41 , 42 …”

Meta‐analysis: Efficacy and safety of albumin in the prevention and treatment of complications in patients with cirrhosis

“…Some reviews have been published analysing the efficacy of albumin administration in cirrhotic patients. Most of them focus only on patients with decompensated liver cirrhosis, [5][6][7] or a single type of complication such as SBP, 8 HRS, 9 HE, 10,11 ascites, 12,13 infections, 14 or hyponatremia. 15 A review by Bai et al examined in 2022 the efficacy of human albumin infusion in cirrhotic patients, but it did not differentiate by comparators, in the main analysis it assessed all types of indications together and analysed only a few outcomes.…”