Sponsored: Human albumin: Focus on liver disease - Page 19
has attracted much attention . 12 Survival rate of patients was improved significantly following early application of albumin and maintaining serum albumin > 3.8g / dl ( especially maintaining levels > 4.0g / dl ) was the basis of standard medical treatment ( SMT ). Compared with SMT , combination treatment with albumin significantly reduced cumulative mortality and the risk of liver-related mortality . Albumin reduced the recurrence of ascites and refractory ascites by improving plasma osmotic pressure and circulating blood volume , so as to prevent serious infections such as SBP , reduce the occurrence of circulatory dysfunction and acute kidney injury ( AKI ) caused by LVP , reduce the rate of liver disease-related death and all-cause death , and improve prognosis .
SBP Antibacterial agents combined with albumin are recommended by the Chinese Society of Hepatology , EASL and AISF-SIMTI for the treatment of SBP , and treatment can reduce the incidence of renal injury and case fatality rate significantly . EASL and AISF- SIMTI recommend higher doses of albumin , starting at 1.5g / kg / d , and then 1g / kg / d on day 3 . 5,7,9 A trial carried out in Egypt showed that albumin combined with antibiotics in patients with liver cirrhosis and SBP significantly reduced the incidence of renal failure , case fatality rate during hospitalisation and 3-month case fatality . 13
HRS As recommended in the Chinese Guideline for Diagnosis and Treatment of Ascites in Patients with Hepatic Cirrhosis , patients with type 1 or 2 HRS can receive terlipressin ( 1mg / 4 – 6 h ) in combination with albumin ( 20 – 40g / d ). If the level of serum creatinine does not decrease by > 25 % after 3 d , the dose can be gradually increased to 2mg / 4h . If there is treatment response reaction , it should be continued for 7 – 14 d . 9 The 2018 EASL clinical practice guidelines recommend using vasoactive agents and albumin in all patients with AKI-HRS > stage 1A as soon as possible . Terlipressin combined with albumin is recommended as first-line treatment for AKI-HRS patients and is also effective in treating type II HRS . 10
Hyponatraemia As stated in the Chinese Rapid Advice Guidelines for the Management of Liver Cirrhosis with Human Albumin and AISF-SIMTI , albumin , on the basis of its physiological mechanism , can be used to treat hyponatraemia that does not respond to routine therapies , especially in hyponatraemic patients awaiting liver transplantation . 5,14 A randomised controlled trial showed that 40g / d albumin infusion based on restrictive fluid and restrictive sodium for patients with refractory ascites and serious hyponatraemia improved blood sodium levels , significantly increased free water clearance and reduced vasopressin . 15