Comparison of outcome in patients with cirrhosis and ascites following treatment with albumin or a synthetic colloid: a randomised controlled pilot trail.
BACKGROUND
The question of which colloid (albumin or synthetic colloids) used for plasma expansion following paracentesis or other complications requiring fluid loading in patients with cirrhosis remains controversial.


OBJECTIVE
To compare outcome and hospital-related cost in patients with cirrhosis treated with 20% human albumin with those treated with a synthetic colloid (3.5% polygeline).


METHODS
The primary end point was occurrence of a first liver-related complication.


RESULTS
When the trial was prematurely discontinued because of safety concerns about bovine-derived products, 30 patients were assigned to receive albumin and 38 were assigned to receive a synthetic colloid. Sixty-three patients were included for ascites removal by paracentesis and five patients for ascites removal by paracentesis and renal impairment. The median time to first liver-related complication was not significantly longer in the albumin group (20 vs. 7 days). However, the total number of liver-related complications adjusted to a 100-day period was significantly lower in the albumin group. The median hospital cost for a 30-day period was significantly lower in the albumin group (1915 euros vs. 4612 euros).


CONCLUSIONS
In patients with cirrhosis and ascites, human albumin appears to be more effective in preventing liver-related complications than synthetic colloid. This may be associated with decreased hospital costs.
Moreau
Richard
R
Service d'Hépatologie and INSERM Unité 481, Hôpital Beaujon, Clichy, France. rmoreau@bichat.inserm.fr
Valla
Dominique-Charles
DC
Durand-Zaleski
Isabelle
I
Bronowicki
Jean-Pierre
JP
Durand
François
F
Chaput
Jean-Claude
JC
Dadamessi
Innocenti
I
Silvain
Christine
C
Bonny
Corinne
C
Oberti
Frédéric
F
Gournay
Jérôme
J
Lebrec
Didier
D
Grouin
Jean-Marie
JM
Guémas
Eric
E
Golly
Dominique
D
Padrazzi
Bruno
B
Tellier
Zéra
Z
D000328:Adult; D000418:Albumins / Q000009:adverse effects / Q000627:therapeutic use*; D001201:Ascites / Q000473:pathology* / Q000628:therapy; D016001:Confidence Intervals; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000473:pathology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000379:methods; D010865:Pilot Projects; D011097:Polygeline / Q000009:adverse effects / Q000627:therapeutic use*; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D000418:Albumins; D011097:Polygeline