Use of human albumin infusion in cirrhotic patients: a systematic review and meta-analysis of randomized controlled trials
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 co...
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| Veröffentlicht in: | Hepatology international 2022-12, Vol.16 (6), p.1468-1483 |
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| description | 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. |
| doi_str_mv | 10.1007/s12072-022-10374-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2709019909</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2709019909</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-ee0bc7a4d29a4e0b69d5aa7373bc3f5627cf053d18e5a2b62015d047d471aae93</originalsourceid><addsrcrecordid>eNp9kUFv1DAQhS0EomXbP8ABWeLCJXRsJ_GGG6qgIFXqhZ6tiTOhrhJ7sR3Q7q_H6ZYiceBgzdP4mzcaPcZeC3gvAPRFEhK0rEDKSoDSdXV4xk5Fp9oKmlo8f9JKnbBXKd0DNE0r2pfsRLVQb5XYnrLDbSIeRn63zOg5Tv0yO8-dH5fkwiq4dTHehews32F25HP6wJGnfco049qO9NPRL45-4DNlrNDjtE8urbaxdMPsDjRwG3yOYZqKzNHhlM7Yi7EUOn-sG3b7-dO3yy_V9c3V18uP15VVuskVEfRWYz3IDuui225oELXSqrdqbFqp7VhuHMSWGpR9K0E0A9R6qLVApE5t2Luj7y6GHwulbGaXLE0TegpLMlJDB6LrYEXf_oPehyWWe1aqhvJkWbVh8kjZGFKKNJpddDPGvRFg1mTMMRlTkjEPyZhDGXrzaL30Mw1PI3-iKIA6Aql8-e8U_-7-j-1vImObbQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2740274205</pqid></control><display><type>article</type><title>Use of human albumin infusion in cirrhotic patients: a systematic review and meta-analysis of randomized controlled trials</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Bai, Zhaohui ; Wang, Le ; Wang, Ran ; Zou, Meijuan ; Méndez-Sánchez, Nahum ; Romeiro, Fernando Gomes ; Cheng, Gang ; Qi, Xingshun</creator><creatorcontrib>Bai, Zhaohui ; Wang, Le ; Wang, Ran ; Zou, Meijuan ; Méndez-Sánchez, Nahum ; Romeiro, Fernando Gomes ; Cheng, Gang ; Qi, Xingshun</creatorcontrib><description>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.</description><identifier>ISSN: 1936-0533</identifier><identifier>EISSN: 1936-0541</identifier><identifier>DOI: 10.1007/s12072-022-10374-z</identifier><identifier>PMID: 36048318</identifier><language>eng</language><publisher>New Delhi: Springer India</publisher><subject>Albumin ; Albumins ; Ascites ; Ascites - etiology ; Cirrhosis ; Clinical trials ; Colorectal Surgery ; Complications ; Health services ; Hepatic encephalopathy ; Hepatic Encephalopathy - complications ; Hepatic Encephalopathy - drug therapy ; Hepatology ; Humans ; Infections ; Liver ; Liver cirrhosis ; Liver Cirrhosis - complications ; Liver Cirrhosis - drug therapy ; Medicine ; Medicine & Public Health ; Meta-analysis ; Mortality ; Original Article ; Paracentesis ; Patients ; Peritonitis ; Peritonitis - microbiology ; Randomized Controlled Trials as Topic ; Renal function ; Serum Albumin, Human - therapeutic use ; Subgroups ; Surgery</subject><ispartof>Hepatology international, 2022-12, Vol.16 (6), p.1468-1483</ispartof><rights>Asian Pacific Association for the Study of the Liver 2022. Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2022. Asian Pacific Association for the Study of the Liver.</rights><rights>Asian Pacific Association for the Study of the Liver 2022. Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-ee0bc7a4d29a4e0b69d5aa7373bc3f5627cf053d18e5a2b62015d047d471aae93</citedby><cites>FETCH-LOGICAL-c375t-ee0bc7a4d29a4e0b69d5aa7373bc3f5627cf053d18e5a2b62015d047d471aae93</cites><orcidid>0000-0002-9448-6739</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12072-022-10374-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s12072-022-10374-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,778,782,27907,27908,41471,42540,51302</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36048318$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bai, Zhaohui</creatorcontrib><creatorcontrib>Wang, Le</creatorcontrib><creatorcontrib>Wang, Ran</creatorcontrib><creatorcontrib>Zou, Meijuan</creatorcontrib><creatorcontrib>Méndez-Sánchez, Nahum</creatorcontrib><creatorcontrib>Romeiro, Fernando Gomes</creatorcontrib><creatorcontrib>Cheng, Gang</creatorcontrib><creatorcontrib>Qi, Xingshun</creatorcontrib><title>Use of human albumin infusion in cirrhotic patients: a systematic review and meta-analysis of randomized controlled trials</title><title>Hepatology international</title><addtitle>Hepatol Int</addtitle><addtitle>Hepatol Int</addtitle><description>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.</description><subject>Albumin</subject><subject>Albumins</subject><subject>Ascites</subject><subject>Ascites - etiology</subject><subject>Cirrhosis</subject><subject>Clinical trials</subject><subject>Colorectal Surgery</subject><subject>Complications</subject><subject>Health services</subject><subject>Hepatic encephalopathy</subject><subject>Hepatic Encephalopathy - complications</subject><subject>Hepatic Encephalopathy - drug therapy</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Infections</subject><subject>Liver</subject><subject>Liver cirrhosis</subject><subject>Liver Cirrhosis - complications</subject><subject>Liver Cirrhosis - drug therapy</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Mortality</subject><subject>Original Article</subject><subject>Paracentesis</subject><subject>Patients</subject><subject>Peritonitis</subject><subject>Peritonitis - microbiology</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Renal function</subject><subject>Serum Albumin, Human - therapeutic use</subject><subject>Subgroups</subject><subject>Surgery</subject><issn>1936-0533</issn><issn>1936-0541</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUFv1DAQhS0EomXbP8ABWeLCJXRsJ_GGG6qgIFXqhZ6tiTOhrhJ7sR3Q7q_H6ZYiceBgzdP4mzcaPcZeC3gvAPRFEhK0rEDKSoDSdXV4xk5Fp9oKmlo8f9JKnbBXKd0DNE0r2pfsRLVQb5XYnrLDbSIeRn63zOg5Tv0yO8-dH5fkwiq4dTHehews32F25HP6wJGnfco049qO9NPRL45-4DNlrNDjtE8urbaxdMPsDjRwG3yOYZqKzNHhlM7Yi7EUOn-sG3b7-dO3yy_V9c3V18uP15VVuskVEfRWYz3IDuui225oELXSqrdqbFqp7VhuHMSWGpR9K0E0A9R6qLVApE5t2Luj7y6GHwulbGaXLE0TegpLMlJDB6LrYEXf_oPehyWWe1aqhvJkWbVh8kjZGFKKNJpddDPGvRFg1mTMMRlTkjEPyZhDGXrzaL30Mw1PI3-iKIA6Aql8-e8U_-7-j-1vImObbQ</recordid><startdate>20221201</startdate><enddate>20221201</enddate><creator>Bai, Zhaohui</creator><creator>Wang, Le</creator><creator>Wang, Ran</creator><creator>Zou, Meijuan</creator><creator>Méndez-Sánchez, Nahum</creator><creator>Romeiro, Fernando Gomes</creator><creator>Cheng, Gang</creator><creator>Qi, Xingshun</creator><general>Springer India</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7U7</scope><scope>C1K</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9448-6739</orcidid></search><sort><creationdate>20221201</creationdate><title>Use of human albumin infusion in cirrhotic patients: a systematic review and meta-analysis of randomized controlled trials</title><author>Bai, Zhaohui ; Wang, Le ; Wang, Ran ; Zou, Meijuan ; Méndez-Sánchez, Nahum ; Romeiro, Fernando Gomes ; Cheng, Gang ; Qi, Xingshun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-ee0bc7a4d29a4e0b69d5aa7373bc3f5627cf053d18e5a2b62015d047d471aae93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Albumin</topic><topic>Albumins</topic><topic>Ascites</topic><topic>Ascites - etiology</topic><topic>Cirrhosis</topic><topic>Clinical trials</topic><topic>Colorectal Surgery</topic><topic>Complications</topic><topic>Health services</topic><topic>Hepatic encephalopathy</topic><topic>Hepatic Encephalopathy - complications</topic><topic>Hepatic Encephalopathy - drug therapy</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Infections</topic><topic>Liver</topic><topic>Liver cirrhosis</topic><topic>Liver Cirrhosis - complications</topic><topic>Liver Cirrhosis - drug therapy</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Mortality</topic><topic>Original Article</topic><topic>Paracentesis</topic><topic>Patients</topic><topic>Peritonitis</topic><topic>Peritonitis - microbiology</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Renal function</topic><topic>Serum Albumin, Human - therapeutic use</topic><topic>Subgroups</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bai, Zhaohui</creatorcontrib><creatorcontrib>Wang, Le</creatorcontrib><creatorcontrib>Wang, Ran</creatorcontrib><creatorcontrib>Zou, Meijuan</creatorcontrib><creatorcontrib>Méndez-Sánchez, Nahum</creatorcontrib><creatorcontrib>Romeiro, Fernando Gomes</creatorcontrib><creatorcontrib>Cheng, Gang</creatorcontrib><creatorcontrib>Qi, Xingshun</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Hepatology international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bai, Zhaohui</au><au>Wang, Le</au><au>Wang, Ran</au><au>Zou, Meijuan</au><au>Méndez-Sánchez, Nahum</au><au>Romeiro, Fernando Gomes</au><au>Cheng, Gang</au><au>Qi, Xingshun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Use of human albumin infusion in cirrhotic patients: a systematic review and meta-analysis of randomized controlled trials</atitle><jtitle>Hepatology international</jtitle><stitle>Hepatol Int</stitle><addtitle>Hepatol Int</addtitle><date>2022-12-01</date><risdate>2022</risdate><volume>16</volume><issue>6</issue><spage>1468</spage><epage>1483</epage><pages>1468-1483</pages><issn>1936-0533</issn><eissn>1936-0541</eissn><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.</abstract><cop>New Delhi</cop><pub>Springer India</pub><pmid>36048318</pmid><doi>10.1007/s12072-022-10374-z</doi><tpages>16</tpages><orcidid>https://orcid.org/0000-0002-9448-6739</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1936-0533 |
| ispartof | Hepatology international, 2022-12, Vol.16 (6), p.1468-1483 |
| issn | 1936-0533 1936-0541 |
| language | eng |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Albumin Albumins Ascites Ascites - etiology Cirrhosis Clinical trials Colorectal Surgery Complications Health services Hepatic encephalopathy Hepatic Encephalopathy - complications Hepatic Encephalopathy - drug therapy Hepatology Humans Infections Liver Liver cirrhosis Liver Cirrhosis - complications Liver Cirrhosis - drug therapy Medicine Medicine & Public Health Meta-analysis Mortality Original Article Paracentesis Patients Peritonitis Peritonitis - microbiology Randomized Controlled Trials as Topic Renal function Serum Albumin, Human - therapeutic use Subgroups Surgery |
| title | Use of human albumin infusion in cirrhotic patients: a systematic review and meta-analysis of randomized controlled trials |
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