Insufficient evidence of benefit regarding mortality due to albumin substitution in HCC‐free cirrhotic patients undergoing large volume paracentesis

Abstract

There is insufficient evidence that the infusion of albumin after LVP significantly lowers mortality in HCC-free patients with advanced liver disease.

Con: The Unclear Benefit of Albumin

“…Therefore, the recommendation for albumin use reaches grade 1A status in international guidelines . However, 2 different conclusions have been reached by separate groups conducting their meta‐analyses for use of albumin in LVP . One group concluded that albumin infusions after LVP improved morbidity and mortality compared to alternative treatments and the other that there was no difference .…”

“…The Barcelona group has demonstrated that a placebo‐controlled trial of HAS against normal saline is possible . Although this study randomized 196 patients, Kütting et al in their meta‐analysis, which included 1277 patients, calculated that at least 1550 additional patients need to be recruited in order to detect or disprove a 25% mortality effect for the use of albumin in LVP . Studies at this scale require substantial funding, and although the establishment of The European Foundation for the Study of Chronic Liver Failure has provided a great opportunity to enable this process, these studies are in reality rarely performed.…”

“…(24,25) One group concluded that albumin infusions after LVP improved morbidity and mortality compared to alternative treatments and the other that there was no difference. (24,25) The primary reason for the lack of statistical significance appears to stem from the inclusion of 2 studies in the former analysis but not the latter as the authors disagreed as to whether these were appropriate. (26) A recent health economic assessment presented in an abstract has suggested that the use of albumin for LVP, SBP, or HRS was cost-effective in both survival and quality-adjusted life-years across Italy, Spain, and Germany.…”

“…(8) Although this study randomized 196 patients, Kütting et al in their meta-analysis, which included 1277 patients, calculated that at least 1550 additional patients need to be recruited in order to detect or disprove a 25% mortality effect for the use of albumin in LVP. (25) Studies at this scale require substantial funding, and although the establishment of The European Foundation for the Study of Chronic Liver Failure has provided a great opportunity to enable this process, these studies are in reality rarely performed. It is hoped that as data systems evolve, "real-world" clinical trials will enable studies of this magnitude to be performed more straightforwardly and at significantly reduced cost.…”

Inhibition of NET‑1 suppresses proliferation and promotes apoptosis of hepatocellular carcinoma cells by activating the PI3K/AKT signaling pathway

“…Hepatocellular carcinoma (HCC) is one of the common malignant tumors worldwide (1). Globally, there are more than 500,000 new cases each year and about 1 million HCC-associated cases of mortality (2)(3)(4)(5)(6). Approximately 40-50% of global HCC cases occur in China and HCC is the second most malignant tumor in China (7)(8)(9)(10).…”