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

Abstract

Summary Introduction Albumin is used in multiple situations in patients with cirrhosis, but the evidence of its benefit is not always clear. The aim was to synthesise the evidence on the efficacy and safety of albumin compared to other treatments or no active intervention in cirrhotic patients. Materials and Methods We conducted a systematic review including randomised controlled trials (RCTs) published in MEDLINE, EMBASE and CENTRAL up to May 2022. We assessed all‐cause mortality, liver transplant, cirrhosis complications of any type and serious adverse events (SAEs). Second, AEs, hospital readmission, length of hospital stay, need for paracentesis and quality of life (QoL) were evaluated. Meta‐analyses with Mantel–Haenszel method and random‐effects model were performed. Results Fifty studies (5118 participants) were included. Albumin was associated with a reduction in mortality in cirrhotic patients with spontaneous bacterial peritonitis (SBP) (RR 0.49, 95% CI 0.32–0.75; low certainty) and hepatic encephalopathy (HE) (RR 0.53, 95% CI 0.34–0.83; low certainty) when compared to no administration of albumin, but not in other scenarios. In general, no additional benefit of albumin was found in liver transplants, SAEs or cirrhosis complications (low/very low certainty). Long‐term administration (>3 months) of albumin led to a reduction in cirrhosis complications (RR 0.75, 95% CI 0.57–0.97; low certainty), hospital readmissions, length of hospital stay, need for paracentesis and improvement of QoL. Conclusion Albumin may reduce mortality risk in cirrhotic patients with SBP or HE. No benefit was identified in reducing liver transplants or SAEs. Long‐term administration may be associated with a lower risk of cirrhosis complications and need for paracentesis.

Effects of social determinants of health on mortality and incident liver‐related events and cardiovascular disease in steatotic liver disease

“… 30 After implementation of these measures, hospitalisations from the two neighbourhoods decreased by 20%. 30 Of note, the effects of SDOH may go beyond the initial diagnosis of decompensated cirrhosis and influence the types of treatment received after decompensation has developed, for example in disparities in use of non-selective beta-blockers, albumin and dietary counselling, 31 – 33 and outreach programmes among these populations may improve clinical outcomes. Outreach programmes aimed at a higher intensity of treatment of SLD in neighbourhoods that are underserved or with high health-related morbidity may include outpatient management of metabolic comorbidities such as diabetes and obesity, programmes to encourage reduction in alcohol intake or integration of lifestyle modification programmes within community spaces which may improve access to care and treatment.…”

Review article: Recent advances in ascites and acute kidney injury management in cirrhosis

“…45 To further clarify the role of albumin in the management of decompensated cirrhosis, several meta-analyses suggested that shortterm use of albumin will reduce the mortality risk in cirrhotic patients with SBP or HE, while long-term albumin infusions will lower the risk of cirrhosis complications and need for paracentesis, but not mortality. [46][47][48] The multi-national PRECIOSA study (NCT03451292) on the effects of long-term albumin infusions in decompensated cirrhosis has just completed patient enrolment. Hopefully, it will provide clearer indications on the use of albumin to improve survival in these patients.…”

Letter: Albumin—Does formulation matter?

“…We read with interest the meta-analysis from Leache et al 1 Although some benefit from long-term albumin administration in cirrhosis was noted, the authors cautioned that results from randomised controlled trials were heterogeneous, and the certainty of evidence was low. Similarly, heterogeneity and low certainty in published data have meant that current American and European guidelines have been unable to reach a consensus recommendation for long-term infusion of human albumin in patients with cirrhosis and ascites.…”