Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Mar 8, 2016; 8(7): 345-354
Published online Mar 8, 2016. doi: 10.4254/wjh.v8.i7.345
Human albumin solution for patients with cirrhosis and acute on chronic liver failure: Beyond simple volume expansion
Christopher Valerio, Eleni Theocharidou, Andrew Davenport, Banwari Agarwal
Christopher Valerio, Banwari Agarwal, Intensive Care Unit, Royal Free Hospital, Royal Free Hampstead NHS Trust, University College London, London NW3 2QG, United Kingdom
Eleni Theocharidou, the Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital, Royal Free Hampstead NHS Trust and Institute of Liver and Digestive Health, University College London, London NW3 2QG, United Kingdom
Andrew Davenport, UCL Centre for Nephrology, Royal Free Hospital, London NW3 2QG, United Kingdom
Author contributions: Davenport A and Agarwal B devised the idea; Valerio C wrote the first draft; Theocharidou E revised the draft; all authors contributed to reviewing articles, editing, revising and preparing the manuscript for publication.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open-Access: 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:
Correspondence to: Banwari Agarwal, MD, Intensive Care Unit, Royal Free Hospital, Royal Free Hampstead NHS Trust, University College London, Pond Street, London NW3 2QG, United Kingdom.
Telephone: +44-20-77940500
Received: October 29, 2015
Peer-review started: November 3, 2015
First decision: November 30, 2015
Revised: December 22, 2015
Accepted: February 14, 2016
Article in press: February 16, 2016
Published online: March 8, 2016
Core Tip

Core tip: Human serum albumin has several important functions beyond being the principal protein in plasma. In disease states, albumin levels may not only be low but there may also be functional hypoalbuminaemia. This may explain why human albumin solution is helpful in treating the complications of cirrhosis whereas its role (as a volume expander) in critical illness remains limited. However, in the presence of cirrhosis or acute liver failure the restoration of functional albumin may be beneficial, even in critically ill patients. This still needs to be addressed in clinical trials.