In the Journals

Albumin may increase survival for some cirrhotic patients with hepatic encephalopathy

A study to determine whether administration of albumin could improve the outcome of hepatic encephalopathy patients instead demonstrated significantly improved survival rates.

“Our study found a major impact of albumin infusion on 90-day survival in patients that experience an episode of HE [hepatic encephalopathy],” the researchers wrote. “The results are independent of the effects on HE, suggesting that HE itself identifies a group of cirrhotic patients with high mortality who benefit from albumin infusion.”

The multicenter, prospective, double blind, controlled trial randomly assigned 56 cirrhotic patients with an acute episode of HE to albumin (1.5g/kg on day 1 and 1g/kg on day 3) or isotonic saline, along with standard treatment (laxatives, 1,200 mg rifaximin daily). The patients were stratified by HE severity (grades 2 and 3 or grade 4). Thirty patients were assigned to saline and 26 to albumin.

Primary endpoint was resolution of HE by day 4; secondary endpoints included survival, length of hospital stay, and biochemical parameters. At day 4, there was no significant difference in patients with HE.

At day 90, 14 initial saline patients had died compared with six in the albumin group. Causes of death were: multiorgan failure (seven in saline group, two in albumin group), sepsis associated with multiorgan failure (four in saline group, three in albumin group) and gastrointestinal bleeding (three in saline group, one in albumin group).

Transplant-free survival among patients in the albumin group demonstrated a comparative HR of 0.37 (CI 95%; 0.16–0.89).

Based on the results, the researchers suggested the need for another study that replicates the design of this study but focuses on survival instead of HE.

 Disclosure: The researchers report no relevant financial disclosures.

A study to determine whether administration of albumin could improve the outcome of hepatic encephalopathy patients instead demonstrated significantly improved survival rates.

“Our study found a major impact of albumin infusion on 90-day survival in patients that experience an episode of HE [hepatic encephalopathy],” the researchers wrote. “The results are independent of the effects on HE, suggesting that HE itself identifies a group of cirrhotic patients with high mortality who benefit from albumin infusion.”

The multicenter, prospective, double blind, controlled trial randomly assigned 56 cirrhotic patients with an acute episode of HE to albumin (1.5g/kg on day 1 and 1g/kg on day 3) or isotonic saline, along with standard treatment (laxatives, 1,200 mg rifaximin daily). The patients were stratified by HE severity (grades 2 and 3 or grade 4). Thirty patients were assigned to saline and 26 to albumin.

Primary endpoint was resolution of HE by day 4; secondary endpoints included survival, length of hospital stay, and biochemical parameters. At day 4, there was no significant difference in patients with HE.

At day 90, 14 initial saline patients had died compared with six in the albumin group. Causes of death were: multiorgan failure (seven in saline group, two in albumin group), sepsis associated with multiorgan failure (four in saline group, three in albumin group) and gastrointestinal bleeding (three in saline group, one in albumin group).

Transplant-free survival among patients in the albumin group demonstrated a comparative HR of 0.37 (CI 95%; 0.16–0.89).

Based on the results, the researchers suggested the need for another study that replicates the design of this study but focuses on survival instead of HE.

 Disclosure: The researchers report no relevant financial disclosures.

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