Infections and rise in systemic inflammation may lead to organ dysfunction and death in patients with decompensated cirrhosis. Even though the anti-inflammatory role of albumin has been proven in preclinical studies, there is a dearth of evidence form large-scale clinical trials. The comparative efficacy of targeting a serum albumin level of 30 g per litre or more in patients with repeated daily infusions of 20% human albumin solution compared with standard care in reducing the incidence of infection, kidney dysfunction, and death is not known. 

In a randomized, multicentre, open-label, parallel-group trial in hospitalized patients with decompensated cirrhosis who had a serum albumin level of less than 30 g per litre at enrolment. The intervention started within 3 days after admission, patients were randomly assigned to receive either targeted 20% human albumin solution for about 14 days or until discharge, whichever came first, or standard care. 

The results showed that in a total of 777 patients, the percentage of patients with a primary end-point event did not differ considerably between the targeted albumin group (113 of 380 patients [29.7%]) and the standard-care group (120 of 397 patients [30.2%]) (adjusted odds ratio, 0.98; 95% CI, 0.71 to 1.33; P=0.87). More severe or life-threatening serious adverse events occurred in the albumin group compared with the standard-care group. 

Based on the results, it was concluded that in patients hospitalized with decompensated cirrhosis, albumin infusion to raise the albumin level to a target of 30 g per litre or more was not more effective than the standard-care treatment. 

Reference

1. China L, Freemantle N, Forrest E, Kallis Y, et al. A randomized trial of albumin infusions in hospitalized patients with cirrhosis. The New England Journal of Medicine. 2021; 384:808-817.