Albumin improves the response to diuretics in patients with cirrhosis and ascites: results of a randomized, controlled trial.
OBJECTIVE
Diuretic treatment of ascites could result in intravascular volume depletion, electrolyte imbalance and renal impairment. We investigated whether intravascular volume expansion with albumin exert beneficial effects in cirrhosis with ascites.


METHODS
In protocol 1, 126 cirrhotic inpatients in whom ascites was not relieved following bed rest and a low-sodium diet, were randomly assigned to receive diuretics (group A) or diuretics plus albumin, 12.5 g/day (group B). In protocol 2, group A patients continued to receive diuretics and group B diuretics plus albumin (25 g/week) as outpatients and were followed up for 3 years. End points were: disappearance of ascites, duration of hospital stay (protocol 1), recurrence of ascites, hospital readmission and survival (protocol 2).


RESULTS
The cumulative rate of response to diuretic treatment of ascites was higher (p < 0.05) and hospital stay was shorter (20 +/- 1 versus 24 +/- 2 days, p < 0.05) in group B than in group A patients. After discharge, group B patients had a lower cumulative probability of developing ascites (19%, 56%, 69% versus 30%, 79% and 82% at 12, 24 and 36 months, p < 0.02) and a lower probability of readmission to the hospital (15%, 56%, 69% versus 27%, 74% and 79%, respectively, p < 0.02). Survival was similar in the two groups.


CONCLUSIONS
Albumin is effective in improving the rate of response and preventing recurrence of ascites in cirrhotic patients with ascites receiving diuretics. However, the cost/benefit ratio was favorable to albumin in protocol 1 but not in protocol 2.
Gentilini
P
P
Institute of Internal Medicine, University of Florence School of Medicine, Italy.
Casini-Raggi
V
V
Di Fiore
G
G
Romanelli
R G
RG
Buzzelli
G
G
Pinzani
M
M
La Villa
G
G
Laffi
G
G
D000328:Adult; D000368:Aged; D001201:Ascites / Q000209:etiology / Q000628:therapy*; D001510:Bed Rest; D001663:Bilirubin / Q000097:blood; D001794:Blood Pressure; D001806:Blood Urea Nitrogen; D002191:Canrenoic Acid / Q000627:therapeutic use; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004232:Diuretics / Q000627:therapeutic use*; D004573:Electrolytes / Q000097:blood; D005260:Female; D005665:Furosemide / Q000627:therapeutic use*; D006525:Hepatitis, Viral, Human / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011336:Probability; D012008:Recurrence; D012709:Serum Albumin / Q000378:metabolism / Q000627:therapeutic use*
D004232:Diuretics; D004573:Electrolytes; D012709:Serum Albumin; D005665:Furosemide; D002191:Canrenoic Acid; D001663:Bilirubin