Human albumin infusion is safe and effective even in patients without acute kidney injury and spontaneous bacterial peritonitis

Anand V Kulkarni; Asim Ahmed Zuberi; K Chaitanya; Harshitha Doolam; Santhosh Reddy; P K Lakshmi; Shubankar Godbole; Venishetty Shantan; Sowmya Iyengar; Manasa Alla; Mithun Sharma; D Nageshwar Reddy; P N Rao

doi:10.1007/s12664-023-01475-0

Human albumin infusion is safe and effective even in patients without acute kidney injury and spontaneous bacterial peritonitis

Indian J Gastroenterol. 2023 Dec 12. doi: 10.1007/s12664-023-01475-0. Online ahead of print.

Authors

Affiliations

¹ Department of Hepatology, AIG Hospitals, Hyderabad, 500 032, India. anandvk90@gmail.com.
² Department of Clinical Pharmacy, AIG Hospitals, Hyderabad, 500 032, India.
³ Department of Pharmacy Practice, G. Pulla Reddy College of Pharmacy, Hyderabad, 500 028, India.
⁴ Department of Hepatology, AIG Hospitals, Hyderabad, 500 032, India.

PMID: 38085502
DOI: 10.1007/s12664-023-01475-0

Abstract

Background and objectives: Human albumin (HA) solution is currently recommended only for patients with spontaneous bacterial peritonitis (SBP) and acute kidney injury (AKI). However, its use in hospitalized patients is quite frequent. The objective was to compare the outcomes of patients receiving HA in recommended (Gr. A) vs. non-recommended (Gr. B) indications.

Methods: In this prospective study, consecutive hospitalized patients who received HA were included. Apart from comparing the proportion of patients achieving resolution of hyponatremia, infection and hepatic encephalopathy among Gr. A and Gr. B, we also compared the in-hospital survival and performed a sub-group analysis of patients with the European Association for the Study of the Liver (EASL) acute-on-chronic liver failure (ACLF) and decompensated cirrhosis (DC).

Results: Of the 396 hospitalized patients who received HA, 180 had AKI and/or SBP (Gr. A), and 216 received albumin for non-recommended indications (Gr. B). The mean age, sex and etiology distribution were similar. The total dose of HA was higher (88 ± 61.62 g vs. 71.31 ± 488.17 g; p = 0.003) and the duration longer (4 ± 2.37 vs. 3.4 ± 1.82 days; p = 0.005) in Gr. A than B. The resolution of infection and HE was similar among both groups, while hyponatremia resolution was significantly higher in Gr. B (94.7%) than Gr. A (75.6%; p < 0.001). On Kaplan-Meier analysis, survival was significantly higher in Gr. B (94%) than Gr. A (78.9%; p < 0.001). The incidence of albumin-induced fluid overload was comparable (2.8% vs. 1.4%; p = 0.32). Patients with ACLF were sicker with a higher incidence of microbiologically proven infection, hepatic encephalopathy (HE) and hyponatremia than in the DC group. Resolution of infection and hyponatremia and in-hospital survival was significantly lower in the ACLF group (72.5%) than in the DC group (92.7%; p < 0.001). Eighty-six per cent of patients achieved resolution of ACLF.

Conclusions: HA infusion is safe and effective even in patients without AKI and SBP and leads to the resolution of infection, hyponatremia, HE and ACLF.

Keywords: Decompensated cirrhosis; Hyponatremia; Infection; Kidney failure; Volume overload.