Skip to main content
Top
Published in:

09-05-2024 | Hepatic Encephalopathy | Original Article

Efficacy of long-term albumin therapy in the treatment of decompensated cirrhosis

Authors: Deepanshu Khanna, Premashis Kar, Pabitra Sahu

Published in: Indian Journal of Gastroenterology | Issue 2/2024

Login to get access

Abstract

Background and Aims

Decompensated liver cirrhosis has a poor prognosis, with a median overall survival of two to four years, which is worse than for many oncological disorders. These patients are highly susceptible to infections due to increased systemic inflammation leading to kidney failure and death. The aim was to study the efficacy of albumin in reducing episodes of decompensation, preventing bacterial infection, kidney dysfunction and mortality.

Method

Study involved patients with Child B or C cirrhosis with an albumin level below 3.0 g/dL, who were administered 20% human albumin weekly with standard medical treatment (SMT) for three months or till serum albumin levels were 4.0 g/dL (whichever is earlier) and compared with age and sex-matched controls who received only SMT. The primary end-point was six-month mortality and the secondary end-points were reduction in infections, kidney dysfunction, ascites recurrence, hepatic encephalopathy (HE), gastrointestinal (GI) bleed and complications of cirrhosis.

Results

From September 2021 to January 2023, 88 cases and 86 controls were taken and followed up for six months. Overall, six-month survival was not statistically significant between groups (95.1% vs. 91.9%; p = 0·330). The incidence of recurrence of ascites (34.09% vs. 59.3%, p < 0.001), kidney dysfunction (6.8% vs. 24.4%, p < 0.001), HE (15.9% vs, 37.2%, p = 0.015), spontaneous bacterial peritonitis (SBP) (3.4% vs 17.4%, p = 0.002) and non-SBP infections (7.9% vs. 18.6%, p = 0.038) were significantly less in cases as compared with controls; however, GI bleed (14.8% vs. 17.4%, p = 0.632) was not statistically significant.

Conclusion

Long-term human albumin acts as a disease-modifying treatment in patients with decompensated cirrhosis.

Graphical abstract

Literature
4.
5.
go back to reference Kunkel HG, Labby DH, Ahrens EH Jr, Shank RE, Hoagland CL. The use of concentrated human serum albumin in the treatment of cirrhosis of the liver. J Clin Invest. 1948;27:305–19.CrossRefPubMedPubMedCentral Kunkel HG, Labby DH, Ahrens EH Jr, Shank RE, Hoagland CL. The use of concentrated human serum albumin in the treatment of cirrhosis of the liver. J Clin Invest. 1948;27:305–19.CrossRefPubMedPubMedCentral
6.
go back to reference European Association for the Study of the Liver. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69:406–60.CrossRef European Association for the Study of the Liver. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69:406–60.CrossRef
7.
go back to reference Runyon BA. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline: management of adult patients with ascites due to cirrhosis 2012. Hepatology. 2013;57:1651–3. Runyon BA. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline: management of adult patients with ascites due to cirrhosis 2012. Hepatology. 2013;57:1651–3.
8.
go back to reference Garioud A, Cadranel J-F, Pauwels A, et al. Albumin use in patients with cirrhosis in France: results of the “ALBU-LIVE” survey: a case for better EASL guidelines diffusion and/or revision. J Clin Gastroenterol. 2017;51:831–8.CrossRefPubMed Garioud A, Cadranel J-F, Pauwels A, et al. Albumin use in patients with cirrhosis in France: results of the “ALBU-LIVE” survey: a case for better EASL guidelines diffusion and/or revision. J Clin Gastroenterol. 2017;51:831–8.CrossRefPubMed
9.
go back to reference Bajaj JS, Tandon P, OʼLeary JG, et al. The impact of albumin use on resolution of hyponatremia in hospitalized patients with cirrhosis. Am J Gastroenterol 2018; 113: 1339. Bajaj JS, Tandon P, OʼLeary JG, et al. The impact of albumin use on resolution of hyponatremia in hospitalized patients with cirrhosis. Am J Gastroenterol 2018; 113: 1339.
10.
go back to reference Simón-Talero M, García-Martínez R, Torrens M, et al. Effects of intravenous albumin in patients with cirrhosis and episodic hepatic encephalopathy: a randomized double-blind study. J Hepatol. 2013;59:1184–92.CrossRefPubMed Simón-Talero M, García-Martínez R, Torrens M, et al. Effects of intravenous albumin in patients with cirrhosis and episodic hepatic encephalopathy: a randomized double-blind study. J Hepatol. 2013;59:1184–92.CrossRefPubMed
11.
go back to reference Garcia-Martinez R, Andreola F, Mehta G, et al. Immunomodulatory and antioxidant function of albumin stabilises the endothelium and improves survival in a rodent model of chronic liver failure. J Hepatol. 2015;62:799–806.CrossRefPubMed Garcia-Martinez R, Andreola F, Mehta G, et al. Immunomodulatory and antioxidant function of albumin stabilises the endothelium and improves survival in a rodent model of chronic liver failure. J Hepatol. 2015;62:799–806.CrossRefPubMed
12.
go back to reference O’Brien AJ, Fullerton JN, Massey KA, et al. Immunosuppression in acutely decompensated cirrhosis is mediated by prostaglandin E2. Nat Med. 2014;20:518–23.CrossRefPubMedPubMedCentral O’Brien AJ, Fullerton JN, Massey KA, et al. Immunosuppression in acutely decompensated cirrhosis is mediated by prostaglandin E2. Nat Med. 2014;20:518–23.CrossRefPubMedPubMedCentral
13.
go back to reference Fernández J, Clària J, Amorós A, et al. Effects of albumin treatment on systemic and portal hemodynamics and systemic inflammation in patients with decompensated cirrhosis. Gastroenterology. 2019;157:149–62.CrossRefPubMed Fernández J, Clària J, Amorós A, et al. Effects of albumin treatment on systemic and portal hemodynamics and systemic inflammation in patients with decompensated cirrhosis. Gastroenterology. 2019;157:149–62.CrossRefPubMed
14.
go back to reference Alcaraz-Quiles J, Casulleras M, Oettl K, et al. Oxidized albumin triggers a cytokine storm in leukocytes through p38 MAP kinase: role in systemic inflammation in decompensated cirrhosis. Hepatology. 2018;68:1937–52.CrossRefPubMed Alcaraz-Quiles J, Casulleras M, Oettl K, et al. Oxidized albumin triggers a cytokine storm in leukocytes through p38 MAP kinase: role in systemic inflammation in decompensated cirrhosis. Hepatology. 2018;68:1937–52.CrossRefPubMed
15.
go back to reference Bajaj JS, O’Leary JG, Reddy KR, et al. Second infections independently increase mortality in hospitalized patients with cirrhosis: the North American Consortium for the Study of End-Stage Liver Disease (NACSELD) experience. Hepatology. 2012;56:2328–35.CrossRefPubMed Bajaj JS, O’Leary JG, Reddy KR, et al. Second infections independently increase mortality in hospitalized patients with cirrhosis: the North American Consortium for the Study of End-Stage Liver Disease (NACSELD) experience. Hepatology. 2012;56:2328–35.CrossRefPubMed
16.
go back to reference Fernández J, Angeli P, Trebicka J, et al. Efficacy of albumin treatment for patients with cirrhosis and infections unrelated to spontaneous bacterial peritonitis. Clin Gastroenterol Hepatol. 2020;18:963–73.e14. Fernández J, Angeli P, Trebicka J, et al. Efficacy of albumin treatment for patients with cirrhosis and infections unrelated to spontaneous bacterial peritonitis. Clin Gastroenterol Hepatol. 2020;18:963–73.e14.
17.
go back to reference Sort P, Navasa M, Arroyo V, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med. 1999;341:403–9.CrossRefPubMed Sort P, Navasa M, Arroyo V, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med. 1999;341:403–9.CrossRefPubMed
18.
go back to reference Thévenot T, Bureau C, Oberti F, et al. Effect of albumin in cirrhotic patients with infection other than spontaneous bacterial peritonitis: a randomized trial. J Hepatol. 2015;62:822–30.CrossRefPubMed Thévenot T, Bureau C, Oberti F, et al. Effect of albumin in cirrhotic patients with infection other than spontaneous bacterial peritonitis: a randomized trial. J Hepatol. 2015;62:822–30.CrossRefPubMed
19.
go back to reference Caraceni P, Riggio O, Angeli P, et al. Long-term albumin administration in decompensated cirrhosis (ANSWER): an open-label randomised trial. Lancet. 2018;391:2417–29.CrossRefPubMed Caraceni P, Riggio O, Angeli P, et al. Long-term albumin administration in decompensated cirrhosis (ANSWER): an open-label randomised trial. Lancet. 2018;391:2417–29.CrossRefPubMed
20.
go back to reference Solà E, Solé C, Simón-Talero M, et al. Midodrine and albumin for prevention of complications in patients with cirrhosis awaiting liver transplantation: a randomized placebo-controlled trial. J Hepatol. 2018;69:1250–9.CrossRefPubMed Solà E, Solé C, Simón-Talero M, et al. Midodrine and albumin for prevention of complications in patients with cirrhosis awaiting liver transplantation: a randomized placebo-controlled trial. J Hepatol. 2018;69:1250–9.CrossRefPubMed
21.
go back to reference Gentilini P, Casini-Raggi V, Di Fiore G, et al. Albumin improves the response to diuretics in patients with cirrhosis and ascites: results of a randomized, controlled trial. J Hepatol. 1999;30:639–45. Gentilini P, Casini-Raggi V, Di Fiore G, et al. Albumin improves the response to diuretics in patients with cirrhosis and ascites: results of a randomized, controlled trial. J Hepatol. 1999;30:639–45.
22.
go back to reference Wilkinson P, Sherlock S. The effect of repeated albumin infusions in patients with cirrhosis. Lancet. 1962;2:1125–9.CrossRefPubMed Wilkinson P, Sherlock S. The effect of repeated albumin infusions in patients with cirrhosis. Lancet. 1962;2:1125–9.CrossRefPubMed
23.
go back to reference Romanelli RG, La Villa G, Barletta G, et al. Long-term albumin infusion improves survival in patients with cirrhosis and ascites: an unblended randomized trial. World J Gastroenterol. 2006;12:1403–7. Romanelli RG, La Villa G, Barletta G, et al. Long-term albumin infusion improves survival in patients with cirrhosis and ascites: an unblended randomized trial. World J Gastroenterol. 2006;12:1403–7.
24.
go back to reference Sola-Vera J, Miñana J, Ricart E, et al. Randomized trial comparing albumin and saline in the prevention of paracentesis-induced circulatory dysfunction in cirrhotic patients with ascites. Hepatology. 2003;37:1147–53. Sola-Vera J, Miñana J, Ricart E, et al. Randomized trial comparing albumin and saline in the prevention of paracentesis-induced circulatory dysfunction in cirrhotic patients with ascites. Hepatology. 2003;37:1147–53.
25.
go back to reference Di Pascoli M, Fasolato S, Piano S, Bolognesi M, Angeli P. Long-term administration of human albumin improves survival in patients with cirrhosis and refractory ascites. Liver Int. 2019;39:98–105. Di Pascoli M, Fasolato S, Piano S, Bolognesi M, Angeli P. Long-term administration of human albumin improves survival in patients with cirrhosis and refractory ascites. Liver Int. 2019;39:98–105.
26.
go back to reference China L, Skene SS, Bennett K, et al. ATTIRE: Albumin To prevent Infection in chronic liver failure: study protocol for an interventional randomised controlled trial. BMJ Open. 2018;8:e023754. China L, Skene SS, Bennett K, et al. ATTIRE: Albumin To prevent Infection in chronic liver failure: study protocol for an interventional randomised controlled trial. BMJ Open. 2018;8:e023754.
28.
go back to reference Bernardi M, Moreau R, Angeli P, Schnabl B, Arroyo V. Mechanisms of decompensation and organ failure in cirrhosis: from peripheral arterial vasodilation to systemic inflammation hypothesis. J Hepatol. 2015;63:1272–84.CrossRefPubMed Bernardi M, Moreau R, Angeli P, Schnabl B, Arroyo V. Mechanisms of decompensation and organ failure in cirrhosis: from peripheral arterial vasodilation to systemic inflammation hypothesis. J Hepatol. 2015;63:1272–84.CrossRefPubMed
29.
go back to reference Garcia-Martinez R, Caraceni P, Bernardi M, Gines P, Arroyo V, Jalan R. Albumin: pathophysiologic basis of its role in the treatment of cirrhosis and its complications. Hepatology. 2013;58:1836–46.CrossRefPubMed Garcia-Martinez R, Caraceni P, Bernardi M, Gines P, Arroyo V, Jalan R. Albumin: pathophysiologic basis of its role in the treatment of cirrhosis and its complications. Hepatology. 2013;58:1836–46.CrossRefPubMed
30.
go back to reference China L, Freemantle N, Forrest E, et al. A randomized trial of albumin infusions in hospitalized patients with cirrhosis. N Engl J Med. 2021;384:808–17. China L, Freemantle N, Forrest E, et al. A randomized trial of albumin infusions in hospitalized patients with cirrhosis. N Engl J Med. 2021;384:808–17.
Metadata
Title
Efficacy of long-term albumin therapy in the treatment of decompensated cirrhosis
Authors
Deepanshu Khanna
Premashis Kar
Pabitra Sahu
Publication date
09-05-2024
Publisher
Springer India
Published in
Indian Journal of Gastroenterology / Issue 2/2024
Print ISSN: 0254-8860
Electronic ISSN: 0975-0711
DOI
https://doi.org/10.1007/s12664-024-01566-6

Other articles of this Issue 2/2024

Indian Journal of Gastroenterology 2/2024 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Webinar | 06-02-2024 | 20:00 (CET)

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

Severe pain is the most common symptom of chronic pancreatitis. In this webinar, experts share the latest insights in pain management for chronic pancreatitis patients. Experts from a range of disciplines discuss pertinent cases and provide practical suggestions for use within clinical practice.

Sponsored by: Viatris

Developed by: Springer Healthcare
Live Webinar | 01-10-2024 | 12:30 (CEST)

Recent advances in the use of CAR T-cell therapies in relapsed/refractory diffuse large B-cell lymphoma and follicular lymphoma

Live: Tuesday 1st October 2024, 12:30-14:00 (CEST)

In this live webinar, Professor Martin Dreyling and an esteemed, international panel of CAR-T experts will discuss the very latest data on the safety, efficacy and clinical impact of CAR T-cell therapies in the treatment of r/r DLBCL and r/r FL, as presented at ASH 2023, EU CAR-T 2024, and EHA 2024. 

Please note, this webinar is not intended for healthcare professionals based in the US and UK.

Sponsored by: Novartis Pharma AG

Chaired by: Prof. Martin Dreyling
Developed by: Springer Healthcare