Open AccessAlbumin administration in patients with cirrhosis: Current role and novel perspectives
Author(s) -
Ângelo Zambam de Mattos,
Douglas A. Simonetto,
Carlos Terra,
Alberto Queiróz Farias,
Paulo Lisboa Bittencourt,
Tales Henrique S Pase,
Marlon Rubini Toazza,
Ângelo Alves de Mattos
Publication year - 2022
Publication title -
world journal of gastroenterology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.427
H-Index - 155
eISSN - 2219-2840
pISSN - 1007-9327
DOI - 10.3748/wjg.v28.i33.4773
Subject(s) - medicine , spontaneous bacterial peritonitis , hepatorenal syndrome , cirrhosis , ascites , decompensation , hepatic encephalopathy , hypoalbuminemia , acute kidney injury , gastroenterology , paracentesis , intensive care medicine , hyponatremia , oncotic pressure , intravascular volume status , albumin , blood pressure
Mortality in cirrhosis is mostly associated with the development of clinical decompensation, characterized by ascites, hepatic encephalopathy, variceal bleeding, or jaundice. Therefore, it is important to prevent and manage such complications. Traditionally, the pathophysiology of decompensated cirrhosis was explained by the peripheral arterial vasodilation hypothesis, but it is currently understood that decompensation might also be driven by a systemic inflammatory state (the systemic inflammation hypothesis). Considering its oncotic and nononcotic properties, albumin has been thoroughly evaluated in the prevention and management of several of these decompensating events. There are formal evidence-based recommendations from international medical societies proposing that albumin be administered in individuals with cirrhosis undergoing large-volume paracentesis, patients with spontaneous bacterial peritonitis, those with acute kidney injury (even before the etiological diagnosis), and those with hepatorenal syndrome. Moreover, there are a few randomized controlled trials and meta-analyses suggesting a possible role for albumin infusion in patients with cirrhosis and ascites (long-term albumin administration), individuals with hepatic encephalopathy, and those with acute-on-chronic liver failure undergoing modest-volume paracentesis. Further studies are necessary to elucidate whether albumin administration also benefits patients with cirrhosis and other complications, such as individuals with extraperitoneal infections, those hospitalized with decompensated cirrhosis and hypoalbuminemia, and patients with hyponatremia.