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Review
. 2020 Jun;8(5):528-535.
doi: 10.1177/2050640620910339. Epub 2020 Feb 26.

Albumin: Indications in chronic liver disease

Manuel Tufoni  1 , Giacomo Zaccherini  1 , Paolo Caraceni  1 , Mauro Bernardi  1
Affiliations
Review

Albumin: Indications in chronic liver disease

Manuel Tufoni et al. United European Gastroenterol J. 2020 Jun.

Abstract

Albumin is currently employed as a plasma expander to prevent and treat specific complications of cirrhosis with ascites, such as the prevention of paracentesis-induced circulatory dysfunction and renal dysfunction induced by spontaneous bacterial peritonitis, as well as the diagnosis and treatment of acute kidney injury and hepatorenal syndrome. Recently, evidence has shown that long-term albumin administration in patients with decompensated cirrhosis reduces mortality and incidence of complications, eases the management of ascites, is cost effective, and has a good safety profile.

Keywords: Liver cirrhosis; acute kidney injury; ascites; hepatorenal syndrome; human albumin; paracentesis; spontaneous bacterial peritonitis.

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Figures

Figure 1.
Figure 1.
Diagnostic algorithm for new onset ascites. Among the additional tests on ascitic fluid, low glucose levels are associated with tuberculosis or peritoneal carcinomatosis and bacterial peritonitis. High concentrations of lactic dehydrogenase (LDH) should lead to the suspicion of a non-hepatic cause, in particular a malignant etiology, peritonitis secondary to intestinal perforation, acute pancreatitis, and tuberculous peritonitis. The combined determination of total proteins, glucose, and LDH has also been proposed to differentiate forms of spontaneous from secondary bacterial peritonitis (proteins > 1 g/dL, glucose <50 mg/dL, high LDH). High levels of amylase can be found in pancreatic ascites or intestinal perforation, ischemia, and mesenteric thrombosis, whereas the dosages of creatinine and bilirubin are useful in the suspicion presence of urine and biliary or intestinal perforation respectively. Opalescent ascitic fluid would require the dosage of triglycerides, as levels higher than 200 mg/dL indicate chylous ascites. An activity of the adenosine-deaminase enzyme (ADA) greater than 39 IU/L suggests the diagnosis of tuberculous ascites, although this dosage is only useful in areas with high prevalence and in the absence of liver cirrhosis. CT: computed-tomography; MR: magnetic resonance.
Figure 2.
Figure 2.
Albumin in decompensated cirrhosis with ascites.
See this image and copyright information in PMC

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