LONG-TERM ALBUMIN THERAPY MAY IMPROVE SURVIVAL IN CIRRHOSIS WITH ASCITES: A SYSTEMATIC REVIEW AND META-ANALYSIS

Introduction and Objectives

Single intravenous albumin infusions are indicated for specific events in decompensated cirrhosis. However, long-term albumin (LTA) use has been debated due to discrepant trial results. In light of recent additional evidence, we evaluated the impact of LTA on mortality in patients with cirrhosis and ascites through a meta-analysis of clinical trials.

Materials and Methods

A systematic review and meta-analysis of randomized and non-randomized trials since 1995 was conducted using PubMed, with manual searches of conference abstracts in the past two years. Eligible studies enrolled adults with cirrhosis and ascites, compared ≥4 weeks of LTA to standard care or placebo, and reported ≥12-month mortality. A random-effects model was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Heterogeneity was evaluated using χ² and I² statistics.

Results

Of 22 studies, 7 met inclusion criteria. Exclusions were due to absent albumin intervention, short treatment duration, or no control group. A total of 711 and 675 patients were included in albumin and control groups, respectively. Death occurred in 131 and 166, respectively. Twelve-month mortality was obtained from all but two trials, which reported 20 and 24-month mortality. The pooled OR for up-to-24 -month mortality was 0.66 [95% CI: 0.47–0.93], indicating a 34% mortality reduction with LTA (Figure). τ² and I² indicated low heterogeneity.

Conclusions

This meta-analysis estimates that, on average, LTA was associated with a one-third reduction in mortality in patients with cirrhosis and ascites. Future analyses of individual-level mortality predictors and other liver-related complications may help identify patients more likely to benefit from LTA.

Conflict of interest: Yes, Cristina Coll-Ortega, Elisabet Viayna, and Thomas Ardiles are employees of Grifols. Rahul Rajkumar is an employee of Boston Strategic Partners, Inc.

Forest plot of odds of mortality up to 24 months with long-term albumin use