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Long-term albumin administration in decompensated cirrhosis (ANSWER): an open-label randomised trial

Caraceni P et al
4 December, 2019  

Ascites, the most common complication of cirrhosis, can rapidly progress to refractory ascites, hyponatraemia, and renal dysfunction, thus greatly increasing morbidity and mortality.

Diuretics and large-volume paracentesis (LVP) are frequently used but do not address the underlying worsening of portal pressure and circulatory state. Hypoalbuminaemia is known to cause ascites through reduction of plasma volume, and administration of human albumin has been associated with improved outcomes for several complications of cirrhosis.

Based on this evidence, a pragmatic study was conducted to compare the long-term use of weekly intravenous human albumin infusions versus diuretics/LVP in patients with decompensated cirrhosis accompanied by persistent ascites following treatment with diuretics.

Albumin administration resulted in a reduction of 38% in the mortality hazard ratio at 18 months and was associated with a decrease in the number of LVP procedures and hospital admissions.

Incidence of refractory ascites, spontaneous bacterial peritonitis, renal dysfunction, hepatorenal syndrome, and hepatic encephalopathy was lower with albumin, but no difference was seen for gastro-oesophageal variceal bleeding.

Age, viral cirrhosis, and the Child-Pugh and Model for End Stage Liver Disease scores showed to be independent predictors of all-cause mortality.

In addition, quality of life suffered a smaller decline in the group receiving albumin, which also showed to be cost-effective.