Outpatient Albumin Infusions Reduce Hospitalizations in Decompensated Cirrhosis: Retrospective Cohort Study

While long-term human albumin administration improves survival in cirrhotic patients with diuretic-resistant ascites, a team of Australian investigators conducted a retrospective cohort study to determine whether there is a significant benefit in more severely affected cases regularly infused with albumin at their institution.

The study population included patients seen at the Royal Melbourne Hospital with a diagnosis of cirrhosis complicated by any of the following: diuretic-refractory (or intolerant) ascites requiring large-volume paracentesis, hepatic hydrothorax or severe peripheral edema. Of a total of 30 patients referred for outpatient albumin infusion between April 1, 2017, and June 30, 2021, 24 patients met the inclusion criteria. The median age was 59.5 years, and etiologies of liver disease included alcohol (n = 12), nonalcoholic steatohepatitis (NASH) (n = 4), hepatitis B or C (n = 2) or other causes (n = 6). Comorbidities include chronic kidney disease. Assessed outcomes includes transjugular intrahepatic portosystemic shunt (TIPS)/transplant-free survival (TTFS) and biochemical and prognostic outcomes. The median follow-up time was 16 months.

Hospital admissions over the six months after initiating albumin infusions fell to 1.04, from a mean of 2.25 hospital admissions prior to albumin therapy. A particularly steep reduction in portal hypertensive-related admissions was observed (relative risk 0.39; 95% confidence interval [CI] 0.21 – 0.69, P = 0.003). The median TTFS significantly improved in patients with a change in the median model for end-stage liver disease-sodium (MELD-Na) ≤1 at one month: 29.4 months versus 7.7 months (P = 0.011). There was also a statistically significant reduction in the median Child-Pugh Score from 9 at baseline to 7.5 (P = 0.017) at 12 months.

This investigation additionally found that presence of type 2 diabetes mellitus (T2DM) significantly increased the risk of TIPS, liver transplant and death. The study authors concluded that T2DM “should be considered as an important factor when assessing patients for human albumin therapy.”