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Liver Failure/ Cirrhosis /Portal Hypertension
Article first published online: 27 MAR 2012
Copyright © 2011 American Association for the Study of Liver Diseases
Volume 55, Issue 4, pages 1172–1181, April 2012
How to Cite
Bernardi, M., Caraceni, P., Navickis, R. J. and Wilkes, M. M. (2012), Albumin infusion in patients undergoing large-volume paracentesis: A meta-analysis of randomized trials. Hepatology, 55: 1172–1181. doi: 10.1002/hep.24786
Potential conflict of interest: Dr. Navickis and Dr. Wilkes received grants from CSL Behring.
This investigation was supported through an unrestricted grant from CSL Behring, King of Prussia, PA.
- Issue published online: 27 MAR 2012
- Article first published online: 27 MAR 2012
- Accepted manuscript online: 16 NOV 2011 09:46AM EST
- Manuscript Accepted: 15 OCT 2011
- Manuscript Received: 16 AUG 2011
Albumin infusion reduces the incidence of postparacentesis circulatory dysfunction among patients with cirrhosis and tense ascites, as compared with no treatment. Treatment alternatives to albumin, such as artificial colloids and vasoconstrictors, have been widely investigated. The aim of this meta-analysis was to determine whether morbidity and mortality differ between patients receiving albumin versus alternative treatments. The meta-analysis included randomized trials evaluating albumin infusion in patients with tense ascites. Primary endpoints were postparacentesis circulatory dysfunction, hyponatremia, and mortality. Eligible trials were sought by multiple methods, including computer searches of bibliographic and abstract databases and the Cochrane Library. Results were quantitatively combined under a fixed-effects model. Seventeen trials with 1,225 total patients were included. There was no evidence of heterogeneity or publication bias. Compared with alternative treatments, albumin reduced the incidence of postparacentesis circulatory dysfunction (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.27-0.55). Significant reductions in that complication by albumin were also shown in subgroup analyses versus each of the other volume expanders tested (e.g., dextran, gelatin, hydroxyethyl starch, and hypertonic saline). The occurrence of hyponatremia was also decreased by albumin, compared with alternative treatments (OR, 0.58; 95% CI, 0.39-0.87). In addition, mortality was lower in patients receiving albumin than alternative treatments (OR, 0.64; 95% CI, 0.41-0.98). Conclusions: This meta-analysis provides evidence that albumin reduces morbidity and mortality among patients with tense ascites undergoing large-volume paracentesis, as compared with alternative treatments investigated thus far. (HEPATOLOGY 2012)