In this episode, I’ll discuss whether albumin infusions improve outcomes in hospitalized patients with decompensated cirrhosis.
Albumin is frequently used for various indications in hospitalized patients, but in some use cases the evidence of benefit is unclear.
Albumin may fall under the laboratory or pharmacy budget depending on how your institution handles it, and stewardship efforts for albumin use are often employed when it falls under the pharmacy budget.
One common use for albumin infusions is hospitalized patients with cirrhosis with low albumin levels. Some clinicians use albumin in the hope that it will reduce infection, kidney injury, and perhaps even mortality. A group of authors recently published in NEJM the results of a randomized, multicenter, open-label, parallel-group trial in the UK examining this issue.
Almost 800 hospitalized cirrhotic patients with albumin levels less than 3g/dL were enrolled. The most common cause for cirrhosis was alcohol. The median total infusion of albumin was 200g. This was compared to patients randomized to a standard of care group. The standard of care group was still allowed to use albumin, however the median dose was 20g per patient in this group.
The authors chose a composite primary end point that was new infection, kidney dysfunction, or death between days 3 and 15 after the initiation of treatment.
There was no significant difference between groups with respect to the primary endpoint. The authors also applied a time-to-event analysis in which data were censored at the time of discharge or at day 15. This also showed no significant between-group difference.
There were numerically more severe or life-threatening serious adverse events in the albumin group than in the standard-care group.
The authors concluded:
In patients hospitalized with decompensated cirrhosis, albumin infusions to increase the albumin level to a target of 30 g per liter or more was not more beneficial than the current standard care in the United Kingdom.
Pharmacists involved in the stewardship of albumin may find the results of this trial helpful. If your department does not handle albumin use, consider passing this article on to the physician chief who supervises the laboratory department that handles requests for albumin.
It should be noted that the study results do not support routine albumin infusions in these patients to achieve a target level, however some hospitalized cirrhotic patients will still be given albumin as part of their treatment.
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