医学
肝硬化
自发性细菌性腹膜炎
肝性脑病
不利影响
内科学
随机对照试验
相对风险
白蛋白
穿刺
重症监护医学
外科
腹水
胃肠病学
置信区间
作者
Leire Leache,Marta Gutiérrez-Valencia,Luis Carlos Saiz,J. Úriz,Federico Bolado,José Antonio García-Erce,L Cantarelli,Juan Erviti
摘要
Albumin is used in multiple situations in patients with cirrhosis, but the evidence of its benefit is not always clear. The aim was to synthesise the evidence on the efficacy and safety of albumin compared to other treatments or no active intervention in cirrhotic patients.We conducted a systematic review including randomised controlled trials (RCTs) published in MEDLINE, EMBASE and CENTRAL up to May 2022. We assessed all-cause mortality, liver transplant, cirrhosis complications of any type and serious adverse events (SAEs). Second, AEs, hospital readmission, length of hospital stay, need for paracentesis and quality of life (QoL) were evaluated. Meta-analyses with Mantel-Haenszel method and random-effects model were performed.Fifty studies (5118 participants) were included. Albumin was associated with a reduction in mortality in cirrhotic patients with spontaneous bacterial peritonitis (SBP) (RR 0.49, 95% CI 0.32-0.75; low certainty) and hepatic encephalopathy (HE) (RR 0.53, 95% CI 0.34-0.83; low certainty) when compared to no administration of albumin, but not in other scenarios. In general, no additional benefit of albumin was found in liver transplants, SAEs or cirrhosis complications (low/very low certainty). Long-term administration (>3 months) of albumin led to a reduction in cirrhosis complications (RR 0.75, 95% CI 0.57-0.97; low certainty), hospital readmissions, length of hospital stay, need for paracentesis and improvement of QoL.Albumin may reduce mortality risk in cirrhotic patients with SBP or HE. No benefit was identified in reducing liver transplants or SAEs. Long-term administration may be associated with a lower risk of cirrhosis complications and need for paracentesis.
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