Patients with chronic liver failure will experience rapid flare of systemic inflammation and oxidative stress in the acute exacerbation stage . Acute failure of multiple organs such as liver , kidney , brain , lung , and coagulation and circulatory systems can occur . It is usually induced by bacterial infection , acute alcoholic hepatitis , or other clinical events , and the short-term mortality rate is high . 12 – 14 As albumin maintains plasma osmotic pressure and other physiological functions , albumin can play a role and have benefit in various stages of complications such as circulatory dysfunction , inflammatory response and oxidative stress in patients with decompensated cirrhosis ( Figure 2 ).
Clinical application of albumin in cirrhosis and complications In view of its plasma expansion effect , albumin was first used in the 1950s to treat cirrhosis hypoalbuminaemia and ascites . 15 With advances in the understanding of liver failure and the physiological functions of human albumin , it started to play an important pharmacological role in many pathophysiological processes . High-quality studies and guidelines in recent years suggest that it can
10 , 16 , 17 improve survival in liver cirrhosis patients .
Treatment of cirrhotic ascites Cirrhotic ascites is often the result of a combination of factors . Portal hypertension is the main cause and primary driving factor for ascites . Imbalances of the renin-angiotensin-aldosterone system and hypoalbuminaemia also play a role in the formation of ascites . Diuretics are recommended by national guidelines as first-line treatments for cirrhotic ascites . 17 – 20 A meta-analysis evaluated the effectiveness and safety of albumin in patients with cirrhotic ascites . 21 The study included eight RCTs . The study group was treated with doses ranging from 5 to 12.5g / d ( in five RCTs ) or 20 to 30g / d ( in three RCTs ). In the combination therapy , dose of furosemide ranged from 20 to 40mg / d . The results showed that for cirrhotic patients with Grade 2 ascites , infusion of albumin combined with diuretics significantly improved the effectiveness of treatment ( RR = 3.43 ; 95 % CI 1.84 – 6.38 ) compared with diuretics or fluid resuscitation only . Meanwhile time to ascites resolution was shortened ( mean difference ( MD ) = -4.04 ; 95 % CI : -4.58 – 3.50 ), urinary sodium excretion ( MD = 10.32 ; 95 % CI 0.14 – 20.49 ) was increased , serum creatinine concentration was decreased ( MD = -3.32 ; 95 % CI -6.60 – -0.05 ). There was no significant difference in the incidence of adverse reactions ( RR = 0.68 , 95 % CI : 0.30 – 1.54 ) and 24h urine output ( MD = 279.00 , 95 % CI -359 . 90 – 917.90 ).
An article that reported the result of a pre-study of an RCT evaluated the economics of albumin for ascites treatment and compared the output of patients with cirrhosis and ascites treated with 20 % human albumin ( n = 30 ) or 3.5 % polygelatin ( n = 38 ). 22 During the 30-day follow-up of the study , there was no significant difference in the incidence of complications between the study group and the control group ( 83 % vs 89 %, p = 0.485 ); the number of cirrhotic complications occurred in the 100-day
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