On-treatment serum albumin tied to survival in patients with cirrhosis, ascites

On-treatment levels of serum albumin strongly predicts survival among patients with cirrhosis and uncomplicated ascites, reports a new posthoc analysis of the ANSWER* study.

ANSWER randomized patients to receive either standard medical treatment alone or in combination with human albumin. Patients were followed for up to 18 months, study interruption, or death; assessments were conducted monthly.

Serum albumin concentrations at baseline were significantly correlated with 18-month mortality, which worsened with every 0.1-g/dL decrease in albumin (hazard ratio [HR], 4.42, 95 percent confidence interval [CI], 2.34–8.33; p<001).

Treatment with human albumin greatly weakened this correlation, however, reducing its magnitude by more than half and closely attenuating its statistical significance (HR, 1.85, 95 percent CI, 0.99–3.49; p=0.055).

Multivariate Cox regression analysis identified 1-month on-treatment serum albumin (per 1-g/dL decrease: HR, 1.083, 95 percent CI, 1.021–1.149; p=0.008) and scores in the model for end stage liver disease incorporating serum sodium (per 1-point increase, HR, 1.217, 95 percent CI, 1.120–1.322; p<0.001) as the only significant predictors of 18-month mortality.

Second-order polynomial regression analysis further confirmed that 18-month survival improves in parallel with 1-month on-treatment serum albumin levels. Moreover, patients who reached the albumin cut-off of ≥4.30 g/dL saw an 80-percent drop in mortality risk than comparators who had failed to achieve this threshold (p<0.001).

“The ANSWER study has shown that long-term albumin administration improves survival and prevents the occurrence of major complications in patients with cirrhosis and ascites,” the researchers said. “[The present] study shows that the achievement of these beneficial effects is related to a significant increase in serum albumin concentration.”

*Albumin for the treatment of ascites in patients with hepatic cirrhosis