A systematic review and meta-analysis of the use of human albumin solution for treating the complications of liver cirrhosis

BACKGROUND: Decompensated liver cirrhosis is characterized by serious complications and high mortality. Intravenous human albumin solution (HAS) has been used for decades to treat these complications, and this systematic review aims to evaluate the clinical effectiveness and safety of HAS and compare it with alternatives. METHODS: We searched MEDLINE (Ovid), Embase (Ovid), and CENTRAL (Cochrane Central Register of Controlled Trials) for Randomized Controlled Trials (RCTs) of HAS to treat liver cirrhosis. RCTs evaluating the use of HAS in cirrhotic adults were eligible. The clinical effect of protocol-guided HAS compared with alternatives on mortality was our principal outcome. Secondary outcomes included renal dysfunction, hepatic encephalopathy, gastrointestinal bleeding, portal hypertensive bleeding, recurrence of ascites, bacterial infections, paracentesis-induced circulatory dysfunction, multiorgan failure, and acute-on-chronic liver failure. Random effect odds ratios (ORs) and their confidence intervals (CIs) were reported. RESULTS: Sixty-eight RCTs were included, with 4 evaluated as low risk of bias. Fifty-six RCTs reported mortality, with a statistically significant reduction in the overall odds of death compared with alternatives. The overall pooled random OR was 0.769 (95% CI 0.652-0.908), p=0.0019. Subgroup analyses grouping trials by size showed that only those with <100 participants demonstrated a significant reduction in overall odds of death (31.3%). HAS reduced the overall OR of renal dysfunction and recurrent ascites. CONCLUSIONS: HAS has shown a reduction in mortality and several complications. However, these benefits were primarily observed in small, low-quality trials, suggesting the need for large, well-designed RCTs before definitive recommendations can be made.