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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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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12072_2022_10374_MOESM1_ESM.jpg
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)
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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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DOI: https://doi.org/10.1007/s12072-022-10374-z