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Human Albumin Infusion for the Management of Liver Cirrhosis and Its Complications: An Overview of Major Findings from Meta-analyses

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Abstract

Introduction

The role of human albumin (HA) infusion in cirrhotic patients has been increasingly recognized. This paper aims to summarize the evidence from meta-analyses regarding HA infusion for the management of cirrhosis and its complications.

Methods

A systematic search in the PubMed, EMBASE, and Cochrane library databases, and in reference lists was conducted. All relevant meta-analyses were identified and their findings were reviewed. The Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) checklist was used to evaluate the methodological quality and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system to assess the quality of evidence for significant outcomes.

Results

Among 300 papers initially identified, 18 meta-analyses have been included. Short- and long-term HA infusion at high doses decreased the mortality of patients with decompensated cirrhosis. In cirrhotic patients with ascites, long-term HA infusion reduced the recurrence of ascites, but not mortality. In cirrhotic patients undergoing large-volume paracentesis (LVP), HA infusion reduced the incidence of post-paracentesis circulatory dysfunction and hyponatremia, but not mortality or renal impairment. In cirrhotic patients with overt hepatic encephalopathy (HE), HA infusion improved the severity of overt HE, but not overall mortality. In cirrhotic patients with spontaneous bacterial peritonitis (SBP), but not those with non-SBP infections, HA infusion reduced the mortality and renal impairment. In cirrhotic patients with type-1 hepatorenal syndrome (HRS), an increment of 100 g in cumulative HA dose increased 1.15-fold survival, but not HRS reversal. In these meta-analyses, the quality of methodology was low or critically low, and that of the evidence was from very low to moderate.

Conclusions

Based on the limited evidence from these meta-analyses, HA infusion appears to be beneficial in cirrhotic patients with ascites, overt HE, and SBP and in those undergoing LVP, but not in those with non-SBP infections.

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Acknowledgements

Funding

No funding was received for this study or for the publication of this article.

Author Contributions

Conceptualization: Xingshun Qi; Methodology: Xiaojie Zheng, Zhaohui Bai, Ting Wang, Fernando G Romeiro, Andrea Mancuso, Cyriac A Philips, Yu J Wong, Filipe G Nery, and Xingshun Qi; Data curation: Xiaojie Zheng, Ting Wang, and Xingshun Qi; Formal analysis and data interpretation: Xiaojie Zheng, Zhaohui Bai, Ting Wang, Fernando G Romeiro, Andrea Mancuso, Cyriac A Philips, Yu J Wong, Filipe G Nery, and Xingshun Qi; Writing-original draft: Xiaojie Zheng and Xingshun Qi; Writing-review and editing: Xiaojie Zheng, Zhaohui Bai, and Xingshun Qi; Supervision: Xingshun Qi. All authors have made an intellectual contribution to the manuscript and approved the submission.

Disclosures

Xiaojie Zheng, Zhaohui Bai, Ting Wang, Fernando G Romeiro, Andrea Mancuso, Cyriac A Philips, Yu J Wong, Filipe G Nery and Xingshun Qi have nothing to disclose.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author notes

  1. Xiaojie Zheng, Zhaohui Bai and Ting Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang, 110840, Liaoning, China

    Xiaojie Zheng, Zhaohui Bai, Ting Wang & Xingshun Qi

  2. Postgraduate College, China Medical University, Shenyang, China

    Xiaojie Zheng & Xingshun Qi

  3. Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, Shenyang, China

    Zhaohui Bai, Ting Wang & Xingshun Qi

  4. Internal Medicine Department, Botucatu Medical School, São Paulo, Brazil

    Fernando G. Romeiro

  5. Medicina Interna 1, Azienda di Rilievo Nazionale ad Alta Specializzazione Civico-Di Cristina-Benfratelli, Palermo, Italy

    Andrea Mancuso

  6. Clinical and Translational Hepatology, The Liver Institute, Center of Excellence in GI Sciences, Rajagiri Hospital, Aluva, India

    Cyriac A. Philips

  7. Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore

    Yu J. Wong

  8. Duke-NUS Medical School, SingHealth, Singapore, Singapore

    Yu J. Wong

  9. Serviço de Cuidados Intensivos, Unidade de Cuidados Intermédios Médico-Cirúrgica, Centro Hospitalar Universitário do Porto, Porto, Portugal

    Filipe G. Nery

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Zheng, X., Bai, Z., Wang, T. et al. Human Albumin Infusion for the Management of Liver Cirrhosis and Its Complications: An Overview of Major Findings from Meta-analyses. Adv Ther 40, 1494–1529 (2023). https://doi.org/10.1007/s12325-023-02430-3

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