TY - JOUR
T1 - Albumin administration in patients with cirrhosis
T2 - Current role and novel perspectives
AU - Alliance of Brazilian Centers for Cirrhosis Care – the ABC Group
AU - de Mattos, Ângelo Zambam
AU - Simonetto, Douglas Alano
AU - Terra, Carlos
AU - Farias, Alberto Queiroz
AU - Bittencourt, Paulo Lisboa
AU - Pase, Tales Henrique Soares
AU - Toazza, Marlon Rubini
AU - de Mattos, Angelo Alves
N1 - Publisher Copyright:
© The Author(s) 2022.
PY - 2022/9/7
Y1 - 2022/9/7
N2 - Mortality in cirrhosis is mostly associated with the development of clinical decompensation, characterized by ascites, hepatic encephalopathy, variceal bleeding, or jaundice. Therefore, it is important to prevent and manage such complications. Traditionally, the pathophysiology of decompensated cirrhosis was explained by the peripheral arterial vasodilation hypothesis, but it is currently understood that decompensation might also be driven by a systemic inflammatory state (the systemic inflammation hypothesis). Considering its oncotic and nononcotic properties, albumin has been thoroughly evaluated in the prevention and management of several of these decompensating events. There are formal evidence-based recommendations from international medical societies proposing that albumin be administered in individuals with cirrhosis undergoing large-volume paracentesis, patients with spontaneous bacterial peritonitis, those with acute kidney injury (even before the etiological diagnosis), and those with hepatorenal syndrome. Moreover, there are a few randomized controlled trials and meta-analyses suggesting a possible role for albumin infusion in patients with cirrhosis and ascites (long-term albumin administration), individuals with hepatic encephalopathy, and those with acute-on-chronic liver failure undergoing modest-volume paracentesis. Further studies are necessary to elucidate whether albumin administration also benefits patients with cirrhosis and other complications, such as individuals with extraperitoneal infections, those hospitalized with decompensated cirrhosis and hypoalbuminemia, and patients with hyponatremia.
AB - Mortality in cirrhosis is mostly associated with the development of clinical decompensation, characterized by ascites, hepatic encephalopathy, variceal bleeding, or jaundice. Therefore, it is important to prevent and manage such complications. Traditionally, the pathophysiology of decompensated cirrhosis was explained by the peripheral arterial vasodilation hypothesis, but it is currently understood that decompensation might also be driven by a systemic inflammatory state (the systemic inflammation hypothesis). Considering its oncotic and nononcotic properties, albumin has been thoroughly evaluated in the prevention and management of several of these decompensating events. There are formal evidence-based recommendations from international medical societies proposing that albumin be administered in individuals with cirrhosis undergoing large-volume paracentesis, patients with spontaneous bacterial peritonitis, those with acute kidney injury (even before the etiological diagnosis), and those with hepatorenal syndrome. Moreover, there are a few randomized controlled trials and meta-analyses suggesting a possible role for albumin infusion in patients with cirrhosis and ascites (long-term albumin administration), individuals with hepatic encephalopathy, and those with acute-on-chronic liver failure undergoing modest-volume paracentesis. Further studies are necessary to elucidate whether albumin administration also benefits patients with cirrhosis and other complications, such as individuals with extraperitoneal infections, those hospitalized with decompensated cirrhosis and hypoalbuminemia, and patients with hyponatremia.
KW - Acute kidney injury
KW - Albumin
KW - Cirrhosis
KW - Hepatorenal syndrome
KW - Paracentesis
KW - Spontaneous bacterial peritonitis
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U2 - 10.3748/wjg.v28.i33.4773
DO - 10.3748/wjg.v28.i33.4773
M3 - Review article
C2 - 36156923
AN - SCOPUS:85138651298
SN - 1007-9327
VL - 28
SP - 4773
EP - 4786
JO - World journal of gastroenterology
JF - World journal of gastroenterology
IS - 33
ER -