Research Paper Volume 11, Issue 19 pp 8502—8525

Albumin infusion may decrease the incidence and severity of overt hepatic encephalopathy in liver cirrhosis

Zhaohui Bai 1, 2, , Mauro Bernardi 3, , Eric M. Yoshida 4, , Hongyu Li 1, , Xiaozhong Guo 1, , Nahum Méndez-Sánchez 5, , Yingying Li 1, , Ran Wang 1, , Jiao Deng 6, , Xingshun Qi 1, ,

  • 1 Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), Shenyang, P.R. China
  • 2 Postgraduate College, Shenyang Pharmaceutical University, Shenyang, P.R. China
  • 3 Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
  • 4 Division of Gastroenterology, Vancouver General Hospital, Vancouver, British Columbia, Canada
  • 5 Liver Research Unit, Medica Sur Clinic and Foundation and Faculty of Medicine, National Autonomous University of Mexico, Mexico
  • 6 Department of Pharmacology, General Hospital of Northern Theater Command, (formerly called General Hospital of Shenyang Military Area), Shenyang, P.R. China

received: August 9, 2019 ; accepted: September 22, 2019 ; published: October 8, 2019 ;

https://doi.org/10.18632/aging.102335
How to Cite

Copyright © 2019 Bai et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background: The role of human albumin infusion for the prevention and treatment of overt hepatic encephalopathy (HE) in liver cirrhosis remains unclear. Results: Among the 708 patients without pre-existing overt HE, albumin infusion significantly decreased the incidence of overt HE (4.20% versus 12.70%, P<0.001) and in-hospital mortality (1.70% versus 5.40%, P=0.008). Among the 182 patients with overt HE at admission or during hospitalization, albumin infusion significantly improved overt HE (84.60% versus 68.10%, P=0.009) and decreased in-hospital mortality (7.70% versus 19.80%, P=0.018). Meta-analysis of 6 studies found that albumin infusion might decrease the risk of overt HE (OR=1.63, P=0.07), but the difference was not statistically significant. Meta-analysis of 3 studies found that albumin infusion significantly improved overt HE (OR=2.40, P=0.04). Conclusions: Based on the results of our retrospective study and meta-analysis, albumin infusion might prevent from the occurrence of overt HE and improve the severity of overt HE in cirrhosis. Our retrospective study also suggested that albumin infusion improved the outcomes of cirrhotic patients regardless of overt HE. Methods: Cirrhotic patients consecutively admitted between January 2010 and June 2014 were considered in a retrospective study. A 1:1 propensity score matching analysis was performed. Additionally, publications regarding albumin infusion for the management of overt HE were systematically searched. Meta-analyses were performed by random-effect model. Odds ratio (OR) was calculated.

Abbreviations

AUGIB: Acute upper gastrointestinal bleeding; CI: Confidence interval; GABA: Gamma-aminobutyric acid; HE: Hepatic encephalopathy; HRS: Hepatorenal syndrome; IL: Interleukin; LOLA: L-ornithine-L-aspartate; MD: Mean difference; MELD: Model for end-stage liver disease; OR: Odds ratio; PPCD: Post-paracentesis circulatory dysfunction; PSM: Propensity score matching; RCTs: Randomized controlled trials; SBP: Spontaneous bacterial peritonitis; TIPS: Transjugular intrahepatic portosystemic shunt; TNF: Tumor necrosis factor.