Albumin Administration is Efficacious in the Management of Patients with Cirrhosis: A Systematic Review of the Literature.

The use of albumin in patients with cirrhosis has been extensively discussed over recent years. Current treatment approaches depend on targeting related complications, aiming to treat and/or prevent circulatory dysfunction, bacterial infections and multi-organ failure. Albumin has been shown to prolong survival and reduce complications in patients with cirrhosis. This review aims to ascertain whether the use of albumin is justified in patients with cirrhosis. A systematic review of randomized controlled trials (RCTs) and meta-analyses evaluating albumin use in patients with cirrhosis published between 1985 and February 2020 was conducted; the quality and risk of bias of the included studies were assessed. In total, 45 RCTs and 10 meta-analyses were included. Based on the included evidence, albumin is superior at preventing and controlling the incidence of cirrhosis complications vs other plasma expanders. Recent studies reported that long-term albumin administration to patients with decompensated cirrhosis improves survival with a 38% reduction in the mortality hazard ratio compared with standard medical treatment alone. Albumin infusions are justified for routine use in patients with cirrhosis, and the use of albumin either alone or in combination with other treatments leads to clinical benefits. Long-term administration of albumin should be considered in some patients.
Competing Interests: Dr Giacomo Zaccherini reports being a part of speaker bureau for Octapharma AG and Grifols SA, outside the submitted work. Dr Manuel Tufoni reports personal fees from Grifols SA and Octapharma AG, outside the submitted work; Grifols SA (speaker bureau). Professor Mauro Bernardi reports personal fees from Grifols SA, Shire/Takeda, CLS Behring GmbH, PPTA, Martin Pharmaceuticals, and Octapharma AG, during the conduct of the study; CSL Behring GmbH (consultant, speaker bureau), Grifols SA (consultant, speaker bureau), Takeda (speaker bureau), PPTA (speaker bureau), Octapharma AG (speaker bureau), Martin Pharmaceuticals (consultant). The authors report no other potential conflicts of interest for this work.
(© 2020 Zaccherini et al.)