Although infusions with human albumin (HA) have been widely used in the past to manage hepatic encephalopathy (HE), its mechanism of action and benefits have not been clearly established, and a heterogenous response to treatment has been reported for patients with different mean serum albumin (ALB) levels.
This study tested the hypothesis that serum ALB can affect the outcomes of HA infusion in hospitalised patients with cirrhosis and overt HE.
A retrospective review of medical records of 2376 cirrhotic patients without overt HE at admission revealed that 4.8% developed this complication while hospitalised; the mortality rate among the 183 cirrhotic patients with overt HE at the time of admission was 10.9%.
Age, presence of infection, levels of ammonia, and prothrombin time were identified as independent risk factors associated with development of overt HE, whereas independent predictors of in-hospital death comprised white blood cell count and total bilirubin.
Decreased ALB levels were also significantly associated with the risk of development of overt HE (≤31.6 g/l) and progression to death (≤22.8 g/l) in the context of cirrhosis. Moreover, patients with low serum ALB levels presented a higher prevalence of ascites.
Future studies should focus on long-term outcomes during follow-up as an outpatient.