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Safety and efficacy of human serum albumin treatment in patients with cirrhotic ascites undergoing paracentesis: A systematic review and meta-analysis

Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL, USA. Electronic address: medhan75@gmail.com. Department of Internal Medicine, BronxCare Health System, Bronx, NY, USA. Electronic address: pravash.budhathoki123@gmail.com. Department of Internal Medicine, Division of Hospital Medicine, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA. Electronic address: YubRaj.Sedhai@vcuhealth.org. Department of Internal Medicine, Our Lady of the Lake Regional Medical Center; Baton Rouge, LA, USA. Electronic address: rbaniya.md@gmail.com. Nepalese Army Institute of Health Sciences, Kathmandu, Nepal. Electronic address: shila.awal@naihs.edu.np. Nepalese Army Institute of Health Sciences, Kathmandu, Nepal. Electronic address: jashpal.yadav@naihs.edu.np. Rangpur Medical College, Rangpur, Bangladesh. Electronic address: lilaawal1998@gmail.com. Department of Internal Medicine, Division of Gastroenterology, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA. Electronic address: Brian.Davis1@vcuhealth.org. Department of Pulmonary Disease and Critical Care Medicine, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA. Electronic address: Markos.Kashiouris@vcuhealth.org. Department of Pulmonary Disease and Critical Care Medicine, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA. Electronic address: Casey.Cable@vcuhealth.org.

Annals of hepatology. 2021;26:100547
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Abstract
Ascites is the most common presentation of decompensated liver cirrhosis. It is treated with therapeutic paracentesis which is associated with several complications. The role of human albumin in patients with cirrhotic ascites remains elusive and has been extensively studied with conflicting results. Thus, in order to fully appraise the available data we sought to perform this systematic review and meta-analysis. Herein we included studies comparing the efficacy and safety of human albumin comparing with other volume expanders and vasoactive agents in patients undergoing paracentesis in cirrhotic ascites. Odds ratio (OR) and mean difference (MD) were used to estimate the outcome with a 95% confidence interval (CI). Albumin use reduced the odds of paracentesis induced circulatory dysfunction (PICD) by 60% (OR 0.40, 95% CI 0.27-0.58). While performing subgroup analysis, albumin use lowered the odds of PICD significantly (OR 0.34, 95% CI 0.22-0.52) in comparison to other colloid volume expanders, but did not lower the odds of PICD in comparison to vasoconstrictor therapy (OR 0.93, 95% CI 0.35-2.45). Albumin was associated with a statistically significant lower incidence of hyponatremia (OR 0.59, 95% CI 0.39-0.88). Albumin did not reduce the overall mortality, readmission rate, recurrence of ascites, mean arterial pressure, incidence of renal impairment, hepatic encephalopathy, and gastrointestinal (GI) bleeding. Thus, treatment with albumin in cirrhotic ascites reduced PICD and hyponatremia although there was no benefit in terms of mortality, readmission rate, recurrence of ascites, hepatic encephalopathy, and GI bleeding.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine