Albumin in Liver Disease -When It’s Helpful

RK Jagdish et al. Hepatology 2021; 74: 2848-2862. Albumin in Advanced Liver Diseases: The Good and Bad of a Drug! (Review)

Useful review –

  • Explains biologic properties -typically 10-15 g of Albumin is synthesized daily (reduced in advanced liver disease). The half-life is between 12-18 days
  • Physiologic functions: oncotic effects, transports proteins/molecules/medications, antithrombotic effects, modulates inflammatory pathways
  • Main uses: beneficial in patients undergoing large-volume paracentesis or who have hepatorenal syndrome or spontaneous bacterial peritonitis.
  • Studies have shown possible modest benefit in long-term albumin administration in patients with cirrhosis, especially ANSWER study which showed a reduction in ascites recurrence, HRS, encephalopathy, infections, hospital admissions and death. Costs of long-term infusion and the lack of benefit in the ATTIRE trial indicate the need for more studies to determine the best approach in this population.
  • Main adverse effects: allergic and transfusion reactions, volume overload, antibody formation and coagulation derangements
  • Generally, albumin infusions are not recommend for correcting isolated hypoalbuminemia. The primary disorder (eg. acute stress, trauma, infection, malignancy) should be treated.