Sponsored: Human albumin: Focus on liver disease - Page 20

plasmapheresis or albumin dialysis . 16 In 2020 , the Society of Critical Care Medicine proposed that albumin can be used for fluid resuscitation in patients with acute liver failure or ACLF . When serum albumin is < 3mg / dl , a dose of 1.2 – 2.0g / kg / d , equivalent to that for critical patients without hepatic failure , is recommended . 17
Recommendations on using albumin in non-SBP infections The Chinese Guideline for Diagnosis and Treatment of Liver Cirrhosis recommends antimicrobial agent + albumin + vasoactive agent for patients with severe infections such as septic and toxic shock . AISF-AMITI proposes that human albumin is safe and effective in treating septic shock in patients with liver cirrhosis . 5 A study carried out in Spain showed that albumin therapy could significantly improve inflammation in patients with non-SBP decompensated liver cirrhosis . Long-term , high-dose albumin therapy can significantly improve patients ’ immune function and reduce the levels of systemic
18 , 19 inflammatory factors in the serum .
Significance of albumin treatment In recent years , the value of albumin treatment has been gradually recognised , that is , serum albumin levels in patients with decompensated liver cirrhosis can reach target values by appropriate infusion , and this forms the basis of the benefit of long-term treatment . A pilot study ( PRECIOSA ) demonstrated that high-dose albumin infusion in patients with hypoalbuminaemia ( serum albumin < 35g / l ) and decompensated cirrhosis effectively improved levels of serum albumin , significantly improved haemodynamics and reduced inflammation . 18 Subsequent analysis of the ANSWER study indicated that following one-month albumin infusion in patients with complex ascites and decompensated cirrhosis , 18-month survival rate in those with serum albumin < 35g / l was significantly lower than those with serum albumin ≥35g / l ( 61.3 % vs 82.4 %, p = 0.02 ). 20
Hepatic failure Human albumin can be used for artificial liver support in patients with hepatic failure . As recommended by the Asian Pacific Association for the Study of Liver in 2019 , patients with acute-onchronic liver failure ( ACLF ) and AKI are treated with intravenous albumin and N-acetylcysteine , to actively treat circulatory failure and maintain a higher mean arterial pressure . Patients with ACLF and hepatic encephalopathy can receive high-dose
Conclusion Hypoalbuminaemia is a significant factor in ascites , hepatic encephalopathy , AKI / HRS and serious infections in patients with liver cirrhosis and hepatic failure . Both international and domestic guidelines have proposed scientific and rational recommendations on the clinical application of albumin in patients with severe liver diseases . Correction of hypoalbuminaemia is a key goal in treating patients and improving prognosis and outcomes .
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use of albumin in patients with liver cirrhosis . Blood Transfus 2016 ; 14 ( 1 ): 8 – 22 . 6 Gatta A , Verardo A , Bolognesi M . Hypoalbuminemia . Intern Emerg Med 2012 ; 7 Suppl 3 : S193 – 9 . 7 European Association for the Study of the Liver . EASL clinical practice guidelines on the management of ascites , spontaneous bacterial peritonitis , and hepatorenal syndrome in cirrhosis . J Hepatol 2010 ; 53 ( 3 ): 397 – 417 . 8 Guidet B et al . The COASST study : cost-effectiveness of albumin in severe sepsis and septic shock . J Crit Care 2007 ; 22 ( 3 ): 197 – 203 . 9 Chinese Society of Hepatology . Chinese guideline for diagnosis and treatment of ascites in
patients with hepatic cirrhosis . J Clin Hepatol 2017 ; 2017 ; 33 ( 10 ). 10 European Association for the Study of the Liver . EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis . J Hepatol 2018 ; 69 ( 2 ): 406 – 60 . 11 Bernardi M et al . Albumin infusion in patients undergoing large-volume paracentesis : a meta-analysis of randomized trials . Hepatology 2012 ; 55 ( 4 ): 1172 – 81 . 12 Caraceni P et al . Longterm albumin administration in decompensated cirrhosis ( ANSWER ): an open-label randomised trial . Lancet 2018 ; 391 ( 10138 ): 2417 – 29 . 13 Abd Elaal MM et al . Evaluation of different therapeutic approaches for spontaneous
bacterial peritonitis . Arab J Gastroenterol 2012 ; 13 ( 2 ): 65 – 70 . 14 Gianotti RJ , Cardenas A . Hyponatraemia and cirrhosis . Gastroenterol Rep ( Oxf ) 2014 ; 2 ( 1 ): 21 – 6 . 15 Jalan R , Mookerjee R , Cheshire L . Albumin infusion for severe hyponatremia in patients with refractory ascites : a randomized clinical trial . J Hepatol 2007 ; 46 ( S1 ): S95 . 16 Sarin SK et al . Correction to : Acute-on-chronic liver failure : consensus recommendations of the Asian Pacific Association for the Study of the Liver ( APASL ): an update . Hepatol Int 2019 ; 13 ( 6 ): 826 – 8 . 17 Nanchal R et al . Guidelines for the management of adult acute and acute-on-chronic liver failure in the ICU :
Cardiovascular , endocrine , hematologic , pulmonary , and renal considerations . Crit Care Med 2020 ; 48 ( 3 ): e173 – e91 . 18 Fernandez J et al . Effects of albumin treatment on systemic and portal hemodynamics and systemic inflammation in patients with decompensated cirrhosis . Gastroenterology 2019 ; 157 ( 1 ): 149 – 62 . 19 Bañares R et al . Metaanalysis of individual patient data of albumin dialysis in acute-onchronic liver failure : focus on treatment intensity . Ther Adv Gastroenterol 2019 ; 12 . 20 Caraceni P et al . Ontreatment serum albumin level can guide long-term treatment in patients with cirrhosis and uncomplicated ascites . J Hepatol 2021 ; 74 ( 2 ): 340 – 9 .
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