The current treatment options for refractory ascites include outpatient paracentesis procedures and transjugular intrahepatic portosystemic shunt (TIPS).
Recent evidence suggests that the long-term use of human albumin in patients with refractory ascites due to decompensated cirrhosis can potentially have a substantial impact on survival owing to its beneficial effects on circulation and cardiac function.
In this non-randomised prospective study, albumin (20g twice-weekly) was tested in 45 patients with cirrhosis associated with refractory ascites in addition to standard of care (SOC) consisting in restricted sodium intake and use of diuretics (but not including TIPS).
The control group comprised 25 patients who received SOC alone. The 2-year mortality rate was significantly lower for the group receiving albumin vs SOC (41.6% vs 65.5%). Use of albumin also resulted in a lower rate of inpatient admissions due to tense ascites or hepatic encephalopathy and bacterial infections.
The incidence of variceal bleeding did not increase following albumin infusion, and no other safety signals were identified.
A univariate analysis showed that age, serum albumin levels and the normalised international ratio, as well as the Child-Turcotte-Pugh score at baseline were associated with risk of death.
Altogether, these findings indicate that albumin constitutes a safe option for the treatment of cirrhosis-associated refractory ascites.