Long‐term administration of human albumin improves survival in patients with cirrhosis and refractory ascites

• DOI: 10.1111/liv.13968
• Publication Date: 2018-09-19T10:39:40Z
• Authors: Marco Di Pascoli; Silvano Fasolato; Salvatore Piano; Massimo Bolognesi; Paolo Angeli
• Keywords: Liver Cirrhosis; Male; 0303 health sciences; Hepatorenal Syndrome; Ascites; Bacterial Infections; Middle Aged; Peritonitis; Long-Term Care; Liver Transplantation; 3. Good health; 03 medical and health sciences; Italy; Risk Factors; Hepatic Encephalopathy; Injections, Intravenous; Multivariate Analysis; Humans; Paracentesis; Female; Prospective Studies; Gastrointestinal Hemorrhage; Proportional Hazards Models

AbstractBackground & AimsIn patients with cirrhosis, the clinical benefit of the treatment with human albumin for ascites is debated, and no data are available regarding refractory ascites. In this study, in patients with cirrhosis and refractory ascites, we assessed the effect of long‐term albumin administration on emergent hospitalization and mortality.MethodsSeventy patients with cirrhosis and refractory ascites, followed at the Unit of Internal Medicine and Hepatology, University and General Hospital of Padova, Italy, were included into the study. Forty‐five patients were non‐randomly assigned to receive long‐term administration of human albumin at the doses of 20 g twice per week (n = 45), in addition to standard medical of care (SOC), and compared to those followed according to SOC. Patients were followed up to the end of the study, liver transplantation or death.ResultsThe cumulative incidence of 24‐month mortality was significantly lower in patients treated with albumin than in the group of patients treated with SOC (41.6% vs 65.5%; P = 0.032). The period free of emergent hospitalization was significantly longer in patients treated with long‐term administration of albumin (P = 0.008). Analysing separately the causes of inpatient admission, patients treated with albumin showed a reduction in the incidence of overt hepatic encephalopathy, ascites, spontaneous bacterial peritonitis (SBP) and non‐SBP infections. In addition, a non‐significant trend towards a reduced probability of hepatorenal syndrome was observed.ConclusionIn patients with cirrhosis and refractory ascites, long‐term treatment with albumin improves survival and reduces the probability of emergent hospitalizations.