Publication: A study on the effect of short-term iv human albumin infusion in hospitalized patients with acute decompensation or complications of chronic liver disease on morbidity and mortality in Hospital University Sains Malaysia
Date
2022
Authors
Zawahid, Norihan
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Abstract
Background: Albumin is the main constituent of plasma oncotic pressure which modulates the distribution of fluid in between the body compartments. Better understanding of albumin's other physiologic functions has expanded its application beyond the maintenance of intravascular volume. In cirrhotic patients, albumin is used to reduce ascites formation, improve circulatory and renal functions, and prevent hepatorenal syndromes in those with spontaneous bacterial peritonitis. However, there is a controversy of whether targeting higher serum albumin would be beneficial in cirrhotic patient due to confirmatory large-scale clinical trials that are still lacking. Therefore, this study aimed at comparing whether an albumin infusion with aiming a higher serum albumin 30 g per litre or more, as compared with standard medical care, would improve short term survival of hospitalized cirrhotic patients. Methods: A retrospective cohort study was conducted in Hospital Universiti Sains Malaysia year 2017 to 2022 on 198 patients between the ages of 27 to 81 years old who had been hospitalized due to decompensated liver disease with serum albumin level of less than 30 g per litre on admission. Patient were screened through either received standard medical therapy with 3 days intravenous human albumin or standard medical therapy alone. The primary composite end point was the survival rate at day 14 after the initiation of treatment or hospitalization with standard medical therapy. The survival time was analysed using Kaplan Meier method and compared between groups by means of the Log-rank test. The changes in parameters between two groups and within the group were tested using repeated measure ANCOVA. survival time among patients who received human albumin as compared to standard medical therapy alone (P<0.001). Repeated measure ANCOVA indicate that mean albumin differed significantly between time points in both standard medical therapies alone (F=37.18, P<0.001) and human albumin group (F=9.833, P=0.002). Multiple comparison analyses with a Bonferroni adjustment revealed that there was a significant increase in mean albumin from initial to the final measurement (adj MD: -1.47, 95% CI: -2.40 to -0.53) for the standard medical therapy with human albumin group. In contrast, the was a significant decrease in mean albumin from initial to final measurement (adj MD: 1.68, 95% CI: 1.13 to 2.23) for the standard medical therapy alone group. Conclusion: Human albumin infusion in an acute decompensated liver cirrhosis is beneficial and notably improved short-term survival of patients. Nevertheless, there is a need for a robust and randomized controlled trials to appraise the use of human albumin with aimed at higher serum albumin level in the treatment of hospitalized patients with cirrhosis-related complications.
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Keywords
liver cirrhosis , Human Albumin