Human albumin infusion for reducing hyponatremia and circulatory dysfunction in liver cirrhosis: A meta-analysis update

Abstract

Background: Liver cirrhosis is a progressive disease with high morbidity and mortality requiring effective management strategies to improve patient outcomes. Various therapies including albumin infusion, volume expanders (VEs), and vasoactive agents are used to manage patients with cirrhosis. Despite numerous clinical trials, a comprehensive meta-analysis comparing the effectiveness of albumin infusion against alternative treatments is limited. This study provides the current and comprehensive synthesis of evidence, offering key insights for optimizing therapeutic strategies in patients with liver cirrhosis.

Aim: To systematically update available data on therapies of liver cirrhosis, we performed a meta-analysis to evaluate and compare the clinical efficacy of albumin infusion vs other VEs and vasoactive agents in patients with liver cirrhosis.

Methods: A literature search from the PubMed and Embase databases (inception till June 2024) focused on hyponatremia (primary outcome) and various outcomes such as gastrointestinal bleeding, hepatic encephalopathy, severe infection, post-paracentesis-induced circulatory dysfunction (PICD), ascites reappearance, spontaneous bacterial peritonitis, hepatorenal syndrome, renal impairment, hospital stay, mortality, and safety was performed. The primary analysis pooled studies that compared albumin infusion with control. In the subgroup analysis, comparisons were made within the stratified treatment categories included in the control group.

Results: Of the 2957 studies retrieved, 31 studies (27 randomized controlled trials and 4 observational studies) comprising 6255 patients were included. Albumin use was significant in reducing odds of hyponatremia [odds ratio (OR) = 0.67; 95% confidence interval (95%CI) = 0.53-0.85] and PICD (OR = 0.38; 95%CI = 0.20-0.71), whereas the reduction in severe infection (OR = 0.55; 95%CI = 0.28-1.07) did not reach statistical significance. In the subgroup analysis, albumin demonstrated a favorable improvement in lowering the incidence of hyponatremia vs inactive/standard medical therapy (OR = 0.54; 95%CI = 0.27-1.09). For PICD, albumin use was significant compared with other VEs (OR = 0.31; 95%CI = 0.11-0.85) but not with vasoconstrictors (OR = 0.63; 95%CI = 0.21-1.91). In the overall subgroup analysis, a significant reduction was observed in hyponatremia (OR = 0.67; 95%CI = 0.53-0.85) and PICD (OR = 0.38; 95%CI = 0.20-0.71).

Conclusion: Human albumin has been shown to significantly reduce the incidence of hyponatremia and PICD in patients with liver cirrhosis, whereas its effect on severe infection remains suggestive but not statistically significant.

Keywords: Albumin; Efficacy; Hepatic encephalopathy; Hyponatremia; Liver cirrhosis; Mortality; Paracentesis-induced circulatory dysfunction; Safety.

Figure 1

PRISMA flow diagram of this study.

Figure 2

Forest plot for hyponatremia outcome comparing albumin with control and hyponatremia comparing albumin and control across other treatment groups. A: Hyponatremia outcome comparing albumin with control; B: Hyponatremia comparing albumin and control across other treatment groups. 95%CI: 95% confidence interval; df: Degrees of freedom; FE: Fixed effect.

Figure 3

Forest plot for post-paracentesis circulatory dysfunction outcome comparing albumin with control and severe infection outcome comparing albumin with control. A: Post-paracentesis circulatory dysfunction outcome comparing albumin with control; B: Severe infection outcome comparing albumin with control. 95%CI: 95% confidence interval; df: Degrees of freedom; FE: Fixed effect.