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Benefits of albumin in cirrhotic patients
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The oncotic power of albumin neutralises the hypovolaemia that develops in cirrhotic patients1
Cirrhotic patients develop portal hypertension, associated with splanchnic arterial vasodilation, deterioration of cardiac function and consequent hypovolaemia.
The administration of albumin not only expands plasma volume and increases cardiac preload and cardiac output, but also induces vasoconstriction at the level of splanchnic microcirculation and, due to its antioxidant properties, plays a crucial role in the transport of physiological substances and the elimination of toxic substances1
Possible mechanism by which human albumin could exert beneficial effects on cirrhosis:2
In liver cirrhosis,
the use of albumin has been shown to
Significantly lower risk of kidney failure2
and lower mortality rates
Significantly longer survival3
In cirrhotic patients with hepatorenal syndrome (HRS), when a combined strategy of albumin infusion with vasoconstrictors was used compared to vasoconstrictors alone,
Lower incidence of
paracentesis-induced circulatory
dysfunction (PICD), hyponatraemia and mortality4
In cirrhotic patients with tense ascites undergoing large-volume paracentesis. large-volume paracentesis.
Reference
Arroyo V, Fernandez J. Pathophysiological basis of albumin use in cirrhosis. Ann Hepatol. 2011 May;10 Suppl 1:S6-14. PMID: 21566249. [PubMed]
Garcia-Martinez R, Caraceni P, Bernardi M, Gines P, Arroyo V, Jalan R. Albumin: pathophysiologic basis of its role in the treatment of cirrhosis and its complications. Hepatology. 2013 Nov;58(5):1836-46. doi: 10.1002/hep.26338. Epub 2013 May 14. PMID: 23423799. [PubMed]
Ortega R, Ginès P, Uriz J, Cárdenas A, Calahorra B, De Las Heras D, Guevara M, Bataller R, Jiménez W, Arroyo V, Rodés J. Terlipressin therapy with and without albumin for patients with hepatorenal syndrome: results of a prospective, nonrandomized study. Hepatology. 2002 Oct;36(4 Pt 1):941-8. doi: 10.1053/jhep.2002.35819. PMID: 12297842. [PubMed]
Bernardi M, Caraceni P, Navickis RJ, Wilkes MM. Albumin infusion in patients undergoing large-volume paracentesis: a meta-analysis of randomized trials. Hepatology. 2012 Apr;55(4):1172-81. doi: 10.1002/hep.24786. PMID: 22095893. [PubMed]
