Patients in the experimental group received infusion of human albumin while those in the control group were administered artificial colloids ( hydroxyethyl starch , dextran-40 , dextran-70 , polygeline , and 0.9 % sodium chloride injection ) or vasoconstrictors ( midodrine , terlipressin , and norepinephrine ). A total of 13 studies were assessed . The results showed lower incidence of PPCD ( 14.8 % versus 31.9 %), lower incidence of hyponatraemia ( 8.1 % versus 15.3 %) and lower hospital mortality ( 9.6 % versus 12.6 %) in the experimental group than in the control group . 16 However , neither meta-analysis mentioned above included any studies in Chinese patients .
In fact , studies of Chinese patients in this area have been undertaken . Chinese researchers reported that there was no survival benefit in the human albumin group than in the dextran-40 17 or dextran-70 18 groups for patients with cirrhotic ascites undergoing paracentesis . There was no advantage of human albumin over hydroxyethyl starch for patients with refractory ascites due to cirrhosis . 19 Compared with mannitol , infusion of human albumin did not result in any differences of effectiveness , time to ascites regression , electrolyte level , and liver and kidney function . 20 , 21 However , the strength of the evidence is debatable , given that all of these studies were single-centre and the sample sizes were small ( 89 cases , 17 46 cases , 18 62 cases , 19 and 68 cases , 21 respectively ). Large-scale multicentre studies in Chinese patients are warranted . In addition , the removed volume of ascites in these studies was either unknown , 17 , 20 or relatively small ( 2 – 3l , 18 < 5l , 19 or 3 – 6 , 21 respectively ). This may be one of the reasons for the negative result . Previous study reported that when the volume of peritoneal fluid removed was not more than 5l , human albumin and artificial colloids ( dextran-70 and polygeline ) had a similar risk of circulatory disturbance , but when the volume of peritoneal fluid removed exceeded 5l , the risk of circulatory disorders in the human albumin group is significantly lower . 22 Therefore , when the removed volume of peritoneal fluid exceeds 5l , the advantages of human albumin have been confirmed .
There is an urgent need to conduct studies on the efficacy and safety of infusion of human albumin and controls ( including no medications , other plasma expanders , and vasoconstrictors ) in Chinese patients with cirrhotic ascites undergoing large volume paracentesis .
Preventing kidney injury and reducing mortality in patients with SBP Human albumin combined with antibacterial drugs can reduce kidney injury after spontaneous bacterial peritonitis ( strength of recommendations and the quality of evidence = 2B ). 2
A number of studies have shown that human albumin plus antibacterial drugs can reduce the risk of kidney injury and reduce mortality in liver cirrhosis patients with SBP . 23 , 24 A similar randomised controlled clinical study was also published in 2001 . The combination of antibacterial drugs with human albumin ( 0.5 – 1g / kg , once every three days , for three weeks ) reduced the risk of kidney injury in cirrhosis patients with SBP from 33.9 % ( 19 / 56 ) in the control group ( antimicrobial drugs alone ) to 8.9 % ( 5 / 56 ), and decreased the in-hospital mortality from 30.4 % ( 17 / 56 ) to 8.9 % ( 5 / 56 ). 25 In 2010 , another team of Chinese researchers published similar study results , demonstrating that the combination of antibacterial drugs with human albumin ( 1g / kg , once a day , for two weeks ) reduced the risk of kidney injury in cirrhosis patients with SBP from 30.6 % ( 15 / 49 ) in the control group ( antimicrobial drugs alone ) to 8.16 % ( 4 / 49 ), and decreased the inhospital mortality rate from 26.5 % ( 13 / 49 ) to 10.2 % ( 5 / 49 ). 26 A Chinese clinical study from Taiwan also suggested that the levels of inflammatory factors ( TNF-α and IL-6 ) in plasma and ascites in cirrhosis patients with SBP significantly decreased after the use of albumin , which may explain , in part , the benefits of albumin . 27
Human albumin may reduce the morbidity and mortality of overt hepatic encephalopathy ( OHE ) Studies have found that the addition of human albumin to conventional treatments can reduce the mortality rate in patients with OHE . 28 , 29 Long-term infusion of albumin can reduce the incidence of hepatic encephalopathy in patients with cirrhosis . 13 A large retrospective study by Chinese researchers also found that human albumin may be beneficial for the prevention and treatment of hepatic encephalopathy . Among the patients without pre-existing OHE , albumin infusion ( 354 cases ) significantly decreased the incidence of OHE ( 4.20 % versus 12.70 %, p < 0.001 ) and in-hospital mortality ( 1.70 % versus 5.40 %, p = 0.008 ) compared with the non-infusion group ( 354 cases ). Among the patients with OHE , albumin infusion ( 91 cases ) significantly improved hepatic encephalopathy ( 84.60 % versus
68.10 %, p = 0.009 ) and decreased mortality ( 7.70 % versus 19.80 % p = 0.018 ) compared with the noninfusion group ( 91 cases ). 30
Human albumin in other patients with liver cirrhosis Studies have found that human albumin plus antibacterial drugs for the treatment of cirrhotic patients with infection other than SBP can benefit the kidney 31 . 32 ; vasoconstrictors plus human albumin can further improve the survival rate of patients with type I hepatorenal syndrome , and there is a dose-dependent response . 33 A small sample retrospective study by Chinese researchers also showed that the improvement of renal function was better in a terlipressin plus human albumin group than in a terlipressin-alone group for the treatment of cirrhotic patients with type I hepatorenal syndrome . 34 However , the results of large-scale prospective clinical studies of Chinese patients with cirrhosis in these fields are not yet available .
Adverse reactions Human albumin is well tolerated , with few adverse reactions and allergic reactions . Among the previously reported adverse reactions , the most
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