Zhou HJ, Li ZQ, Dili DE, Xie Q. Human albumin infusion for reducing hyponatremia and circulatory dysfunction in liver cirrhosis: A meta-analysis update. World J Hepatol 2025; 17(6): 106418 [DOI: 10.4254/wjh.v17.i6.106418]
Corresponding Author of This Article
Qing Xie, PhD, Chief Physician, Full Professor, Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai 200025, China. xieqingrjh@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Jun 27, 2025; 17(6): 106418 Published online Jun 27, 2025. doi: 10.4254/wjh.v17.i6.106418
Human albumin infusion for reducing hyponatremia and circulatory dysfunction in liver cirrhosis: A meta-analysis update
Hui-Juan Zhou, Zi-Qiang Li, Da-Er Dili, Qing Xie
Hui-Juan Zhou, Zi-Qiang Li, Qing Xie, Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
Da-Er Dili, Takeda (China) Holding Co., Ltd., Shanghai 200025, China
Co-first authors: Hui-Juan Zhou and Zi-Qiang Li.
Author contributions: Zhou HJ and Li ZQ contribute equally to this study as co-first authors; Zhou HJ and Li ZQ were responsible for study concept and design; Li ZQ was responsible for acquisition of data; Dili DE was responsible for analysis and interpretation of data; Dili DE and Xie Q were responsible for drafting of the manuscript; Zhou HJ was responsible for critical revision of the manuscript for important intellectual content; Dili DE was responsible for administrative, technical, or material support; Zhou HJ and Xie Q were responsible for study supervision; all authors have made a significant contribution to this study and have approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 82070604 and No. 82270618; and the Shanghai Municipal Key Clinical Specialty, China, No. shslczdzk01103.
Conflict-of-interest statement: All authors have no conflicts of interest to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
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: Qing Xie, PhD, Chief Physician, Full Professor, Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Shanghai 200025, China. xieqingrjh@163.com
Received: February 27, 2025 Revised: April 15, 2025 Accepted: June 3, 2025 Published online: June 27, 2025 Processing time: 119 Days and 5 Hours
Abstract
BACKGROUND
Liver cirrhosis is a progressive disease with high morbidity and mortality requiring effective management strategies to improve patient outcomes. Various therapies including albumin infusion, volume expanders (VEs), and vasoactive agents are used to manage patients with cirrhosis. Despite numerous clinical trials, a comprehensive meta-analysis comparing the effectiveness of albumin infusion against alternative treatments is limited. This study provides the current and comprehensive synthesis of evidence, offering key insights for optimizing therapeutic strategies in patients with liver cirrhosis.
AIM
To systematically update available data on therapies of liver cirrhosis, we performed a meta-analysis to evaluate and compare the clinical efficacy of albumin infusion vs other VEs and vasoactive agents in patients with liver cirrhosis.
METHODS
A literature search from the PubMed and Embase databases (inception till June 2024) focused on hyponatremia (primary outcome) and various outcomes such as gastrointestinal bleeding, hepatic encephalopathy, severe infection, post-paracentesis-induced circulatory dysfunction (PICD), ascites reappearance, spontaneous bacterial peritonitis, hepatorenal syndrome, renal impairment, hospital stay, mortality, and safety was performed. The primary analysis pooled studies that compared albumin infusion with control. In the subgroup analysis, comparisons were made within the stratified treatment categories included in the control group.
RESULTS
Of the 2957 studies retrieved, 31 studies (27 randomized controlled trials and 4 observational studies) comprising 6255 patients were included. Albumin use was significant in reducing odds of hyponatremia [odds ratio (OR) = 0.67; 95% confidence interval (95%CI) = 0.53-0.85] and PICD (OR = 0.38; 95%CI = 0.20-0.71), whereas the reduction in severe infection (OR = 0.55; 95%CI = 0.28-1.07) did not reach statistical significance. In the subgroup analysis, albumin demonstrated a favorable improvement in lowering the incidence of hyponatremia vs inactive/standard medical therapy (OR = 0.54; 95%CI = 0.27-1.09). For PICD, albumin use was significant compared with other VEs (OR = 0.31; 95%CI = 0.11-0.85) but not with vasoconstrictors (OR = 0.63; 95%CI = 0.21-1.91). In the overall subgroup analysis, a significant reduction was observed in hyponatremia (OR = 0.67; 95%CI = 0.53-0.85) and PICD (OR = 0.38; 95%CI = 0.20-0.71).
CONCLUSION
Human albumin has been shown to significantly reduce the incidence of hyponatremia and PICD in patients with liver cirrhosis, whereas its effect on severe infection remains suggestive but not statistically significant.
Core Tip: Liver cirrhosis is one of the leading causes of death worldwide, which imposes a substantial public health burden. The efficacy of various therapies, such as albumin infusion, volume expanders (VEs), and vasoactive drugs, used to treat patients with cirrhosis is still not clear. This meta-analysis compares albumin infusion, VEs, and vasoactive agents for the treatment of liver cirrhosis. Albumin infusion significantly decreases hyponatremia and paracentesis induced circulatory dysfunction compared to other treatments. These findings indicate that albumin therapy is more effective against complications of liver cirrhosis compared to other treatments.
