Current indications for the use of albumin in the treatment of cirrhosis

The role of proteins in the maintenance of colloid osmotic pressure has been described by Starling since 1896. For many decades, the importance of albumin was associated exclusively to its colloid osmotic function. More recently, other properties of albumin have been demonstrated, such as: carrying different substances, anti-inflammatory activity, preserving capillaries permeability, anti-oxidant role. It is noteworthy that, in decompensated cirrhosis, there is qualitative and quantitative decrease in albumin function. This is why, when we use it, we must have in mind its pharmacological role, as well as its colloid osmotic function. Currently, albumin has three major indications in the treatment of cirrhosis. The first would be in the treatment of tense or refractory ascites, when large-volume paracentesis are accomplished, maily when more than 4-5L of ascites are drained, in order to avoid post-paracentesis dysfunction. The second would be in cases of spontaneous bacterial peritonitis, avoiding renal impairment and increasing survival; it is formally indicated when bilirubin is greater than 4 mg/dL or creatinine is greater than 1 mg/dL. Finally, we understand its use associated to terlipressin seems to be the best treatment strategy for type I hepatorenal syndrome. Hence, its judicial use is of great relevance and benefit in the treatment of these complications of the cirrhotic patient.