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. 2023 Mar;57(6):620-634.
doi: 10.1111/apt.17344. Epub 2022 Dec 15.

Meta-analysis: Efficacy and safety of albumin in the prevention and treatment of complications in patients with cirrhosis

Leire Leache  1   2 , Marta Gutiérrez-Valencia  1   2 , Luis Carlos Saiz  1   2 , Juan Uriz  3 , Federico Bolado  3 , José Antonio García-Erce  4   5 , Lorenzo Cantarelli  6 , Juan Erviti  1   2
Affiliations

Meta-analysis: Efficacy and safety of albumin in the prevention and treatment of complications in patients with cirrhosis

Leire Leache et al. Aliment Pharmacol Ther. 2023 Mar.

Abstract

Introduction: Albumin is used in multiple situations in patients with cirrhosis, but the evidence of its benefit is not always clear. The aim was to synthesise the evidence on the efficacy and safety of albumin compared to other treatments or no active intervention in cirrhotic patients.

Materials and methods: We conducted a systematic review including randomised controlled trials (RCTs) published in MEDLINE, EMBASE and CENTRAL up to May 2022. We assessed all-cause mortality, liver transplant, cirrhosis complications of any type and serious adverse events (SAEs). Second, AEs, hospital readmission, length of hospital stay, need for paracentesis and quality of life (QoL) were evaluated. Meta-analyses with Mantel-Haenszel method and random-effects model were performed.

Results: Fifty studies (5118 participants) were included. Albumin was associated with a reduction in mortality in cirrhotic patients with spontaneous bacterial peritonitis (SBP) (RR 0.49, 95% CI 0.32-0.75; low certainty) and hepatic encephalopathy (HE) (RR 0.53, 95% CI 0.34-0.83; low certainty) when compared to no administration of albumin, but not in other scenarios. In general, no additional benefit of albumin was found in liver transplants, SAEs or cirrhosis complications (low/very low certainty). Long-term administration (>3 months) of albumin led to a reduction in cirrhosis complications (RR 0.75, 95% CI 0.57-0.97; low certainty), hospital readmissions, length of hospital stay, need for paracentesis and improvement of QoL.

Conclusion: Albumin may reduce mortality risk in cirrhotic patients with SBP or HE. No benefit was identified in reducing liver transplants or SAEs. Long-term administration may be associated with a lower risk of cirrhosis complications and need for paracentesis.

Keywords: adverse events; albumin; ascites; efficacy; hepatic encephalopathy; hepatology; liver cirrhosis; spontaneous bacterial peritonitis; systematic review.

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Comment in

  • Letter: Albumin-Does formulation matter? Authors' reply.
    Leache L, Gutiérrez-Valencia M, Saiz LC, Uriz J, Bolado F, García-Erce JA, Cantarelli L, Erviti J. Leache L, et al. Aliment Pharmacol Ther. 2023 Jun;57(12):1484-1485. doi: 10.1111/apt.17546. Aliment Pharmacol Ther. 2023. PMID: 37243460 No abstract available.
  • Letter: Albumin-Does formulation matter?
    Yu C, Iqbal A, Garg M, Sood S, Lewis D. Yu C, et al. Aliment Pharmacol Ther. 2023 Jun;57(12):1482-1483. doi: 10.1111/apt.17531. Aliment Pharmacol Ther. 2023. PMID: 37243466 No abstract available.

References

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