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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Albumin administration in patients with cirrhosis: Current role and novel perspectives
Ângelo Zambam de Mattos, Douglas Alano Simonetto, Carlos Terra, Alberto Queiroz Farias, Paulo Lisboa Bittencourt, Tales Henrique Soares Pase, Marlon Rubini Toazza, Angelo Alves de Mattos, Alliance of Brazilian Centers for Cirrhosis Care – the ABC Group
Ângelo Zambam de Mattos, Angelo Alves de Mattos, Graduate Program in Medicine: Hepatology, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Brazil
Douglas Alano Simonetto, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55902, United States
Carlos Terra, Department of Gastroenterology, State University of Rio de Janeiro, Rio de Janeiro 20550-170, Brazil
Alberto Queiroz Farias, Department of Gastroenterology, University of São Paulo, São Paulo 01246-903, Brazil
Paulo Lisboa Bittencourt, Gastroenterology and Hepatology Unit, Hospital Português, Salvador 40130-030, Brazil
Tales Henrique Soares Pase, Internal Medicine Unit, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
Marlon Rubini Toazza, Gastroenterology and Hepatology Unit, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
Author contributions: All authors contributed to this paper with conception of the manuscript, literature review and analysis, drafting and critical revision of the manuscript, and approval of the final version of the paper.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ângelo Zambam de Mattos, MD, MSc, PhD, Professor, Graduate Program in Medicine: Hepatology, Federal University of Health Sciences of Porto Alegre, 245, Sarmento Leite Street, Porto Alegre 90050-170, Brazil. angmattos@hotmail.com
Received: March 27, 2022
Peer-review started: March 27, 2022
First decision: May 9, 2022
Revised: June 5, 2022
Accepted: July 5, 2022
Article in press: July 5, 2022
Published online: September 7, 2022
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.
Core tip: Mortality in cirrhosis is mostly associated with clinical decompensation. Albumin has oncotic and nononcotic properties, which may contribute to the prevention and management of such complications. This review discusses the current recommendations and the novel perspectives regarding the use of albumin in cirrhosis.
