Original Article
Copyright ©2011 Baishideng Publishing Group Co.
World J Gastroenterol. Aug 14, 2011; 17(30): 3479-3486
Published online Aug 14, 2011. doi: 10.3748/wjg.v17.i30.3479
Table 1 Levels of evidence and strength of recommendation
Levels of evidence
1Randomized clinical trials and/or meta-analyses
2Single randomized clinical trail
3Prospective observational studies
4Retrospective studies
5Cross-sectional surveys and descriptive studies
6Opinion of experts in guidelines or consensus
Strength of recommendations
AStrong (levels of evidence 1 and 2)
BRelatively strong (levels of evidence 3, 4 and 5)
CWeak (level of evidence 6)
Table 2 Practical recommendations for the prescription of albumin at the S Orsola-Malpighi University Hospital, Bologna, Italy
Acute diseasesFirst-line treatmentSecond-line treatment
Hypovolemic shock [1, A]Colloid/crystalloid solutionsHuman albumin if:
Sodium intake restriction
Hypersensitivity to colloids or crystalloids
Lack of response to combined use of colloids and crystalloids
Major surgery [6, C]
(1) Cardiovascular surgeryColloid/crystalloid solutionsHuman albumin if:
Lack of response to combined use of colloids and crystalloids
As for hypovolemic shock
(2) Other surgeryAs for hypovolemic shock
Burns [6, C]Colloid/crystalloid solutionsHuman albumin plus crystalloid solutions if:
Lack of response to colloid or crystalloid solutions alone
Severe burns (> 50% body surface)
Chronic diseasesFirst-line treatmentSecond-line treatment
CirrhosisHuman albumin
(1) Paracentesis [1, A]8 g/L of removed ascites if paracentesis > 4 L
(2) Spontaneous bacterial peritonitis [1, A]1.5 g/kg at diagnosis and 1 g/kg on third day + antibiotic therapy
(3) Hepatorenal syndrome [1, A]1 g/kg at diagnosis followed by 20-40 g/d + vasoconstrictors
(4) Ascites [1, A]Diuretic treatmentHuman albumin if: Ascites resistant to diuretics
Plasmapheresis [6, C]Human albumin if plasma changes > 20 mL/kg per week
Protein wasting enteropathy/malnutritionEnteral or parenteral nutritionHuman albumin only if:
severe diarrhea (> 2 L/d)
albuminemia < 2 g/dL
clinical hypovolemia
Table 3 Distribution of albumin consumption and cost among clinical indications in 2008
Vials (number)(%)Cost (euros)Patients (number)(%)Vials/patients (number)Cost/patient (euros)
Cirrhosis19 871 (52)534.532807 (36.3)24.6662
Major surgery6196 (16.2)166.982495 (22.2)12.5337
Shock5069 (13.3)136.558447 (20)11.3305
Enteric disease2982 (7.8)80.215146 (6.5)20.4549
Plasmapheresis2333 (6.1)62.75754 (2.4)43.21162
Mars196 (0.5)5.2726 (0.2)32.6878
Others1201 (0.5)5353.000149 (6.7)7.1260
Extra-protocol1240 (3.7)33.418119 (5.3)10.5281
Table 4 Distribution of albumin consumption and cost among the clinical indications for cirrhosis in 2008
Vials (number)(%)Cost (euros)Patients (number)(%)Vials/patients (number)Cost/patient (euros)
Ascites12.540 (63.3)337.976453 (56.4)27.7746
Paracentesis4.564 (23.1)122.988222 (27.6)20.6554
Hepatorenal syndrome2.340 (11.8)63.070106 (13.2)22.0595
Spontaneous bacterial peritonitis367.000 (1.8)9.88022 (2.7)14.0380