From the Guidelines
Albumin administration is recommended for patients with decompensated cirrhosis and ascites, as it has been shown to improve morbidity and mortality, with a 38% reduction in the mortality hazard ratio, as demonstrated in the ANSWER study 1. The use of albumin in end-stage liver disease (ESLD) has been explored in various studies, with a focus on its potential to improve outcomes in patients with decompensated cirrhosis and ascites.
- Key benefits of albumin administration in ESLD include:
- Improved survival rates, as seen in the ANSWER study, where patients receiving weekly outpatient human albumin solution (HAS) infusions had a significantly higher 18-month survival rate compared to those receiving standard medical therapy alone 1
- Reduced incidence of infection and renal dysfunction, as observed in the ANSWER study, where the HAS group had a lower incidence rate ratio for infection and renal dysfunction compared to the standard therapy group 1
- Potential benefits in preventing complications of cirrhosis, although this was not consistently demonstrated across all studies, such as the MACHT study, which found no significant difference in complications or survival between the treatment and placebo groups 1 In clinical practice, albumin administration can be considered as part of a comprehensive treatment plan for patients with decompensated cirrhosis and ascites, taking into account individual patient needs and circumstances.
- Important considerations for albumin administration in ESLD include:
- The potential for confounding effects, such as improved standard of care, in studies where albumin administration is accompanied by regular medical professional contact, as seen in the ANSWER study 1
- The need for further research to fully understand the benefits and limitations of albumin administration in ESLD, particularly in different patient populations and clinical contexts.
From the Research
Utility of Albumin in ESLD
- Albumin is beneficial in patients with advanced and decompensated cirrhosis, particularly in those undergoing large-volume paracentesis or who have hepatorenal syndrome or spontaneous bacterial peritonitis 2.
- Albumin improves the functionality of immune cells and mitigates the severity and risk of infections in advanced cirrhosis 2.
- Long-term administration of albumin can modify the course of decompensated cirrhosis patients by reducing the onset of new complications, improving quality of life, and possibly providing survival benefits 2.
- However, the use of albumin is not without adverse events, including allergic and transfusion reactions, volume overload, antibody formation, and coagulation derangements 2.
Indications for Albumin Administration
- Fluid replacement in plasmapheresis and liver diseases, including hepatorenal syndrome, spontaneous bacterial peritonitis, and large-volume paracentesis, have a moderate to high quality of evidence and a strong recommendation for administering albumin 3.
- Albumin administration is most indicated in the management of cirrhosis complications, such as fluid resuscitation or treatment of severe and refractory edema, especially in patients with hypoalbuminemia and not responding to other treatments 3.
Combination Therapy with Albumin
- A combination of midodrine, octreotide long-acting release (LAR), and albumin resulted in a significant reduction in plasma renin and aldosterone concentrations and a trend towards a reduction in the volume of ascites removed by paracentesis in patients with refractory ascites 4.
- However, this combination therapy was associated with a reversible deterioration in the model for end-stage liver disease (MELD) score 4.
Serum Albumin Significance
- Hypoalbuminemia is a major risk factor for morbidity and mortality in the ESRD population, but serum albumin level is not a reliable indicator of nutritional status due to multifactorial causes of hypoalbuminemia 5.