Review Article

Albumin Reduces Paracentesis-Induced Circulatory Dysfunction and Reduces Death and Renal Impairment among Patients with Cirrhosis and Infection: A Systematic Review and Meta-Analysis

Table 2

Treatment groups, followup, and results.

StudyAlbumin groupControl groupDuration of followupResults

Abdel-Khalek and Arif 2010 [19]Paracentesis and IV 20% albumin 8 g/L of ascitic fluid removed.Paracentesis and hydroxyethyl starch 6%.Up to 11 months.Bacterial infection 3/68 versus 3/67, death 5/68 versus 6/67, encephalopathy 3/68 versus 2/67, GI bleeding 5/68 versus 5/67, readmissions 32/68 versus 37/67.

Altman et al. 1998 [20]Paracentesis and IV 20% albumin 100 mL if <2 L of ascites removed, 200 mL if 2–5 L of ascitic fluid removed.Paracentesis and hydroxyethyl starch 200 mL/L of ascetics fluid removed.Up to 15 days after paracentesis.Encephalopathy 1/33 versus 0/27, GI bleeding 0/33 versus 1/27, hyponatraemia 0/33 versus 1/27, severe infection 2/33 versus 3/27.

Choi et al. 2002 [21]Paracentesis and albumin 6–8 g/L of ascitic fluid removed.General management.Followup at 7 days.Death 3/21 versus 2/19, encephalopathy 2/21 versus 0/19, hyponatremia 4/21 versus 2/19, renal impairment 3/21 versus 1/19.

Fassio et al. 1992 [22]Paracentesis with albumin 6 g/L of ascitic fluid removed.Paracentesis with dextran 70 6 g/L of ascitic fluid removed.In-hospital outcomes.Death 6/21 versus 6/20, encephalopathy 1/21 versus 2/20, GI bleeding 3/21 versus 0/20, hyponatremia 4/21 versus 3/20, readmission 6/21 versus 5/20, renal impairment 1/21 versus 1/20, sepsis 2/21 versus 1/20.

Garcia-Compean
et al. 1993 [23]
Paracentesis with albumin 5 g/L of ascitic fluid removed.Paracentesis without albumin.5 days.Encephalopathy 1/17 versus 0/18, hyponatremia 1/17 versus 1/18, renal impairment 1/17 versus 2/18.

García-Compean
et al. 2002 [24]
Paracentesis with albumin infusion 8 g/L of ascitic fluid removed.Paracentesis with 8 g/L Dextran solution (10 mg Dextran-40 and 5 g sorbitol per 100 mL)14 months.Death 11/48 versus 18/48, hyponatremia 3/48 versus 5/48, readmission 30/48 versus 34/48, renal impairment 7/48 versus 2/48.

Gines et al. 1988 [2]Paracentesis 4–6 L/day until resolution and IV 20% albumin infusion (40 g after each tap).Paracentesis without albumin.27 months.Death 18/51 versus 14/50, hyponatremia 1/51 versus 2/52, readmission 29/51 versus 36/50, renal impairment 0/51 versus 1/50.

Gines et al. 1996 [25]Paracentesis with IV albumin 8 g/L of ascitic fluid removed.Group II: Paracentesis and IV dextran-70 (8 g/L of ascitic fluid) and Group 3: Paracentesis with IV polygeline (8 g/L of ascitic fluid).NABacterial infection 5/97 versus 3/99, deaths 2/97 versus 6/99, encephalopathy 3/97 versus 5/99, GI bleeding 1/97 versus 1/99, hyponatremia 14/97 versus 19/99, PPCD 17/92 versus 37/98, renal impairment 7/97 versus 10/99.

Guevara et al. 2012 [26]Antibiotics plus 20% albumin (1.5 g/kg then 1 g/kg).Best infection care with antibiotics but not albumin.3 months.Death 8/56 versus 10/54, renal impairment 1/56 versus 4/54.

Moreau et al. 2006 [27]Paracentesis and 20% albumin replacement.Paracentesis and 3.5% polygeline.6 months.Hyponatraemia 8/29 versus 15/38.

Nazar et al. 2009 [28]Antibiotics plus albumin (1.5 g/kg then 1 g/kg).Best infection care with antibiotics but not albumin.3 months.Infection resolution 55/56 versus 50/54, renal impairment 3/56 versus 4/54.

Planas et al. 1990 [29]Paracentesis and IV 20% albumin 8 g/L of ascitic fluid removed.Paracentesis and dextran-70 8 g/L ascitic fluid removed.27.5 weeks versus 23.7 weeks.Death 13/43 versus 17/45, encephalopathy 3/43 versus 3/45, GI bleeding 1/43 versus 3/45, hyponatraemia 3/43 versus 4/45, readmissions 24/43 versus 29/43, renal impairment 1/43 versus 1/45, severe infection 1/43 versus 2/45.

Salemo 1991 [35]Paracentesis and IV 20% albumin 30 mL/L of ascitic fluid removed.Paracentesis and IV haemaccel 3.5% 150 mL/L of ascitic fluid removed.NA.Encephalopathy 2/27 versus 2/27, hyponatraemia 4/27 versus 5/27, readmissions 17/27 versus 12/27, renal impairment 1/27 versus 1/27.

Sola-Vera et al. 2003 [30]Paracentesis and IV 20% albumin 8 g/L of ascitic fluid removed.Paracentesis and 170 mL of 3.5% saline/L of ascites removed.NA.Death 1/37 versus 1/35, hyponatraemia 2/37 versus 5/35, PICD 4/37 versus 11/35, renal impairment 2/37 versus 3/35.

Sort et al. 1999 [8]IV cefotaxime 2 g dosing based on serum creatinine and 20% albumin 1.5 g/kg during first 6 hours, then 1 g/kg on day 3.IV cefotaxime dosing based on creatinine.NA.Death in hospital 6/63 versus 18/63, death at three months 14/63 versus 26/63, infection resolution 62/63 versus 59/63, renal impairment 6/63 versus 21/63.

Xue et al. 2002 [31]IV ceftriaxone plus IV albumin 0.5–1.0 g/kg within 6 hours of enrolment, then same amount on 3rd day and every 3 days thereafter. IV ceftriaxone 3 g/day adjusted based on serum creatinine.NA.Renal impairment 5/56 versus 19/56, deaths 5/56 versus 17/56.

NA: not available.