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Use of human albumin infusion in cirrhotic patients: a systematic review and meta-analysis of randomized controlled trials

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Abstract

Background

Human albumin infusion is effective for controlling systemic inflammation, thereby probably managing some liver cirrhosis-related complications, such as spontaneous bacterial peritonitis (SBP), hepatic encephalopathy (HE), and hepatorenal syndrome. However, its clinical benefits remain controversial.

Methods

EMBASE, PubMed, and Cochrane Library databases were searched. Randomized controlled trials (RCTs) regarding use of human albumin infusion in cirrhotic patients were eligible. Mortality and incidence of liver cirrhosis-related complications were pooled. Effect of human albumin infusion on mortality was also evaluated by subgroup analyses primarily according to target population and duration of human albumin infusion treatment. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.

Results

Forty-two RCTs were finally included. Meta-analysis showed that human albumin infusion could significantly decrease the mortality of cirrhotic patients (OR = 0.81, 95% CI = 0.67–0.98, p = 0.03). Subgroup analyses showed that human albumin infusion could significantly decrease the mortality of cirrhotic patients with SBP (OR = 0.36, 95% CI = 0.20–0.64, p = 0.0005) and HE (OR = 0.43, 95% CI = 0.22–0.85, p = 0.02), but not those with ascites or non-SBP infections or undergoing large-volume paracentesis. Short-term human albumin infusion treatment could significantly decrease short-term mortality (OR = 0.67, 95% CI = 0.50–0.89, p = 0.005), but not long-term mortality. Long-term human albumin infusion treatment could not significantly decrease long-term mortality (OR = 0.72, 95% CI = 0.48–1.08, p = 0.11). In addition, human albumin infusion could significantly decrease the incidence of renal impairment (OR = 0.63, 95% CI = 0.45–0.88, p = 0.007) and ascites (OR = 0.45, 95% CI = 0.25–0.81, p = 0.007), but not infections or gastrointestinal bleeding.

Conclusions

Human albumin infusion may improve the outcomes of cirrhotic patients. However, its indications for different complications and infusion strategy in liver cirrhosis should be further explored.

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Data availability

Data sharing is not applicable to this article as no new data were created in this study.

Abbreviations

CI:

Confidence interval

HE:

Hepatic encephalopathy

HRS:

Hepatorenal syndrome

LVP:

Large-volume paracentesis

OR:

Odds ratio

SBP:

Spontaneous bacterial peritonitis

RCT:

Randomized controlled trial

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. The authors have no relevant financial or non-financial interests to disclose.

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Author notes

  1. Zhaohui Bai and Le Wang are the co-first authors.

  2. Xingshun Qi and Gang Cheng are the co-corresponding authors.

Authors and Affiliations

  1. Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, Liaoning, China

    Zhaohui Bai, Le Wang, Ran Wang & Xingshun Qi

  2. NMPA Key Laboratory for Research and Evaluation of Drug Regulatory Technology, Shenyang Pharmaceutical University, Shenyang, Liaoning, China

    Zhaohui Bai, Meijuan Zou, Gang Cheng & Xingshun Qi

  3. Postgraduate College, China Medical University, Shenyang, Liaoning, China

    Le Wang

  4. Medica Sur Clinic and Foundation and Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico

    Nahum Méndez-Sánchez

  5. Botucatu Medical School, São Paulo State University (UNESP), São Paulo, Brazil

    Fernando Gomes Romeiro

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  1. Zhaohui Bai
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Contributions

Conceptualization: XQ; methodology: ZB and XQ; formal analysis: ZB, LW, RW, and XQ; data curation: ZB, LW, RW, and XQ; writing–original draft: ZB, LW, and XQ; writing–review and editing: ZB, GC, MZ, LW, RW, NM-S, FGR, and XQ; supervision: GC and XQ. All the authors have made an intellectual contribution to the manuscript and approved the submission.

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Correspondence to Xingshun Qi.

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Zhaohui Bai, Le Wang, Ran Wang, Meijuan Zou, Nahum Méndez-Sánchez, Fernando Gomes Romeiro, Gang Cheng, and Xingshun Qi declare that they have no conflict of interest.

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The current study is a systematic review and meta-analysis of published data, so the informed consent is not applicable.

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Supplementary file1: Supplementary Figure 1. Risk of bias of RCTs. Notes: # Singh et al. published 2 randomized controlled trials whose study designs were different (JPG 262 kb)

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Supplementary file2: Supplementary Figure 2. Forrest plot showing the effect of human albumin infusion on mortality in subgroup analysis based on baseline serum albumin level. Notes: * Ginès et al. published a randomized controlled trial where there are 2 different control groups, including polygeline and dextran. # Singh et al. published 2 randomized controlled trials whose study designs were different (JPG 266 kb)

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Supplementary file3: Supplementary Figure 3. Forrest plot showing the effect of human albumin infusion on mortality in subgroup analysis based on the severity of liver cirrhosis. Notes: * Ginès et al. published a randomized controlled trial where there are 2 different control groups, including polygeline and dextran. # Singh et al. published 2 randomized controlled trials whose study designs were different (JPG 259 kb)

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Supplementary file4: Supplementary Figure 4. Forrest plot showing the effect of short-term human albumin infusion on mortality in subgroup analysis based on the dose of human albumin. Notes: * Ginès et al. published a randomized controlled trial where there are 2 different control groups, including polygeline and dextran. # Singh et al. published 2 randomized controlled trials whose study designs were different (JPG 128 kb)

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Supplementary file5: Supplementary Figure 5. Forrest plot showing the effect of long-term human albumin infusion on mortality in subgroup analysis based on the dose of human albumin (JPG 243 kb)

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Supplementary file6: Supplementary Figure 6. Forrest plot showing the effect of human albumin infusion on the rate of improvement of severity of complications (JPG 142 kb)

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Supplementary file7: Supplementary Figure 7. Forrest plot showing the effect of human albumin infusion on the prevention of renal impairment in cirrhotic patients. Notes: * Ginès et al. published a randomized controlled trial where there are 2 different control groups, including polygeline and dextran. # Singh et al. published 2 randomized controlled trials whose study designs were different (JPG 61 kb)

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Supplementary file8: Supplementary Figure 8. Forrest plot showing the effect of human albumin infusion on the prevention of de-novo or recurrent ascites in cirrhotic patients. Notes: # Singh et al. published 2 randomized controlled trials whose study designs were differentú (JPG 2268 kb)

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Supplementary file9: Supplementary Figure 9. Sensitivity analysis regarding the effect of human albumin infusion on the prevention of de-novo or recurrent ascites in cirrhotic patients (JPG 97 kb)

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Supplementary file10: Supplementary Figure 10. Forrest plot showing the effect of human albumin infusion on the prevention of infections in cirrhotic patients. Notes: * Ginès et al. published a randomized controlled trial where there are 2 different control groups, including polygeline and dextran (JPG 262 kb)

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Supplementary file11 Supplementary Figure 11. Forrest plot showing the effect of human albumin infusion on the prevention of gastrointestinal bleeding in cirrhotic patients. Notes: * Ginès et al. published a randomized controlled trial where there are 2 different control groups,including polygeline and dextran (JPG 93 kb)

Supplementary file12 (DOCX 35 kb)

Supplementary file13 (DOCX 25 kb)

Supplementary file14 (DOCX 36 kb)

Supplementary file15 (DOCX 20 kb)

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Bai, Z., Wang, L., Wang, R. et al. Use of human albumin infusion in cirrhotic patients: a systematic review and meta-analysis of randomized controlled trials. Hepatol Int 16, 1468–1483 (2022). https://doi.org/10.1007/s12072-022-10374-z

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