diuretics alone . 3 – 11 ( Table 1 ). Although these are all single-centre studies and the number of cases in each study is limited , these studies were conducted in multiple provinces and cities throughout China and the total number of cases exceeded 700 . Therefore , the conclusions of the study are reliable .
There are few Chinese studies comparing the efficacy of human albumin and other expanders in the treatment of ascites due to cirrhosis . A single-centre study suggests there is no difference in short-term efficacy between human albumin and mannitol . 12 However , taking into account the risks that other expanders may cause , these are not recommended in the treatment of patients with ascites due to cirrhosis when human albumin is available .
Clinical studies of the efficacy and safety of long-term application of human albumin in the treatment of ascites due to cirrhosis in Chinese patients are lacking . However , a Chinese group conducted a meta-analysis of five non-Chinese studies , including the ANSWER study , 13 with a total of 803 patients . The results showed that the experimental group ( long-term infusion of human albumin combined with diuretics ) presented better overall survival ( hazard ratio ( HR ) = 0.60 ; 95 % CI 0.44 – 0.83 ; p = 0.002 ), lower incidence of complications ( relative risk ( RR ) = 0.35 ; 95 % CI 0.18 – 0.69 ; p = 0.002 ), lower rate of rehospitalisation ( RR = 0.23 ; 95 % CI 0.13 – 0.43 ; p < 0.001 ) and lower ascites recurrence rate ( RR = 0.17 ; 95 % CI 0.07 – 0.42 ; p < 0.001 ) compared with the control group ( diuretics alone ). There was no significant difference in the incidence of adverse reactions between the two groups ( p > 0.05 ). The authors concluded that long-term treatment with human albumin can improve overall survival and reduce the incidence of complications and readmissions without increasing the incidence of adverse reactions in patients with liver cirrhosis who require long-term management of ascites . 14
Human albumin in preventing PPCD Human albumin is recommended to prevent PPCD ( strength of recommendations and quality of evidence = 1A ). 2
A meta-analysis of 17 randomised trials published in 2012 showed that infusion of human albumin can reduce morbidity and mortality among patients with tense ascites undergoing large-volume paracentesis , as compared with other plasma expanders . 15 In 2015 , a Chinese team conducted a meta-analysis on the efficacy of infusion of human albumin in cirrhotic patients undergoing large-volume paracentesis .
TABLE 1
Clinical studies on comparing diuretics alone or combined with human albumin in the treatment of Chinese patients with cirrhosis and ascites in recent years
Region |
Object |
Control group , |
Experimental group , |
Results ( experimental |
Reference |
|
|
number of cases |
number of cases |
group vs control group ) |
|
Jiangsu |
Refractory ascites |
Furosemide , 52 |
Furosemide + human |
Faster decline of ascites ; |
3 |
|
due to cirrhosis |
|
albumin , 52 |
faster relief of abdominal distension ; fewer adverse reactions |
|
Jiangsu |
Refractory ascites |
Furosemide , 17 |
Furosemide + human |
Higher total |
4 |
|
due to cirrhosis |
|
albumin , 17 |
effectiveness rate ; |
|
|
|
|
|
fewer adverse reactions |
|
Shanxi |
Refractory ascites |
Diuretic , 26 |
Diuretic + human |
Higher |
5 |
|
due to cirrhosis |
|
albumin , 26 |
effectiveness rate |
|
Jilin |
Ascites due to cirrhosis |
Furosemide , 69 |
Furosemide + human |
Faster decline of ascites , |
6 |
|
|
|
albumin , 71 |
faster relief of abdominal distension , fewer adverse reactions |
|
Sichuan |
Ascites due to cirrhosis |
Furosemide , 48 |
Furosemide + human |
Faster decline of ascites , |
7 |
|
|
|
albumin , 48 |
faster relief of abdominal distension , fewer adverse reactions |
|
Hubei |
Ascites due to cirrhosis |
Furosemide , 48 |
Furosemide + human |
Faster decline of ascites , |
8 |
|
|
|
albumin , 48 |
faster relief of abdominal distension , fewer adverse reactions |
|
Jiangxi |
Elderly patients with |
Diuretics and other |
Conventional treatments |
Higher total |
9 |
|
ascites due to cirrhosis |
conventional |
+ human albumin , 41 |
effectiveness rate , |
|
|
|
treatments , 41 |
|
fewer adverse reactions |
|
Guangdong |
Ascites due to cirrhosis |
Torasemide , 35 |
Torasemide + human |
Faster decline of ascites , |
10 |
|
|
|
albumin , 35 |
faster relief of abdominal |
|
|
|
|
|
distension |
|
Guangxi |
Refractory ascites due to |
Diuretic , 17 |
Diuretic + human |
Higher effectiveness rate |
11 |
|
cirrhosis |
|
albumin , 17 |
|
|
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