Albumin confers survival benefit in select patients with cirrhosis

Treatment with albumin appears to cut the risk of death in cirrhotic patients with spontaneous bacterial peritonitis or hepatic encephalopathy, with long-term treatment potentially lowering the risk of cirrhosis complications and need for paracentesis, according to the results of a meta-analysis.

Researchers searched multiple online databases for studies that provided evidence on the efficacy and safety of albumin compared to other treatments or no active intervention in cirrhotic patients. The outcomes examined were all-cause mortality, liver transplant, cirrhosis complications of any type, and serious adverse events (SAEs). Other outcomes evaluated were AEs, hospital readmission, length of hospital stay, need for paracentesis, and quality of life.

The search yielded 50 studies, which involved a total of 5,118 participants, for inclusion in the meta-analysis. Data were pooled using the Mantel–Haenszel method and random-effects model.

Compared with no albumin, albumin administration led to a lower mortality risk in cirrhotic patients with spontaneous bacterial peritonitis (relative risk [RR], 0.49, 95 percent confidence interval [CI], 0.32–0.75; low certainty of evidence) or hepatic encephalopathy (RR, 0.53, 95 percent CI, 0.34–0.83; low certainty of evidence). This survival benefit with albumin was not observed when compared with other treatment scenarios.

Overall, albumin provided no additional beneficial effect on liver transplants, SAEs, or cirrhosis complications (low/very low certainty).

However, long-term albumin administration (>3 months) was associated with a reduction in cirrhosis complications (RR, 0.75, 95 percent CI, 0.57–0.97; low certainty), hospital readmissions, length of hospital stay, and need for paracentesis, as well as an improvement in QoL.