Albumin reduces paracentesis-induced circulatory dysfunction and reduces death and renal impairment among patients with cirrhosis and infection: a systematic review and meta-analysis.
BACKGROUND
Studies have suggested that albumin has a value in cirrhotic patients undergoing paracentesis but its value in infection and sepsis is less clear. We planned to perform a meta-analysis of the risk of adverse outcomes in cirrhotic patients with and without albumin use.


METHODS
We searched MEDLINE and EMBASE in January 2013 for randomized studies of cirrhotic patients that reported the risk of adverse events and mortality with albumin and no albumin exposure. We performed random effects meta-analysis and assessed heterogeneity using the I² statistic.


RESULTS
Our review included 16 studies covering 1,518 patients. The use of albumin in paracentesis was associated with significantly reduced risk of paracentesis-induced circulatory dysfunction (OR 0.26 95%, CI 0.08-0.93) and there was a nonsignificant difference in death, encephalopathy, hyponatraemia, readmission, and renal impairment. Compared to the other volume expanders, albumin use showed no difference in clinical outcomes. In cirrhotic patients with any infection, there was a significant reduction in mortality (OR 0.46 95%, CI 0.25-0.86) and renal impairment (OR 0.34 95%, CI 0.15-0.75) when albumin was used.


CONCLUSIONS
The use of albumin in cirrhotic patients is valuable in patients with any infection and it reduces the risk of circulatory dysfunction among patients undergoing paracentesis.
Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK.
Chun Shing
CS
Kwok
Lukasz
L
Krupa
Ash
A
Mahtani
Duncan
D
Kaye
Simon M
SM
Rushbrook
Martin G
MG
Phillips
William
W
Gelson
D000418:Albumins / Q000008:administration & dosage*; D005355:Fibrosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007239:Infections / Q000188:drug therapy* / Q000453:epidemiology; D016239:MEDLINE; D019152:Paracentesis
D000418:Albumins