Albumin infusion in patients undergoing large-volume paracentesis: A meta-analysis of randomized trials.
Hepatology. 2011 Nov 16. doi: 10.1002/hep.24786. [Epub ahead of print]
Albumin infusion reduces the incidence of post-paracentesis circulatory dysfunction among patients with cirrhosis and tense ascites, as compared with no treatment. Treatment alternatives to albumin such as artificial colloids and vasoconstrictors have been widely investigated. The aim of this meta-analysis was to determine whether morbidity and mortality differ between patients receiving albumin vs. alternative treatments. The meta-analysis included randomized trials evaluating albumin infusion in patients with tense ascites. Primary endpoints were post-paracentesis circulatory dysfunction, hyponatremia and mortality. Eligible trials were sought by multiple methods, including computer searches of bibliographic and abstract databases and the Cochrane Library. Results were quantitatively combined under a fixed effects model. Seventeen trials with 1225 total patients were included. There was no evidence of heterogeneity or publication bias. Compared with alternative treatments, albumin reduced the incidence of post-paracentesis circulatory dysfunction (odds ratio, 0.39; 95% confidence interval, 0.27-0.55). Significant reductions in that complication by albumin were also shown in subgroup analyses vs. each of the other volume expanders tested (dextran, gelatin, hydroxyethyl starch and hypertonic saline). The occurrence of hyponatremia was also decreased by albumin compared with alternative treatments (odds ratio, 0.58; 95% confidence interval, 0.39-0.87). In addition, mortality was lower in patients receiving albumin than alternative treatments (odds ratio, 0.64; 95% confidence interval, 0.41-0.98). Conclusions: This meta-analysis provides evidence that albumin reduces morbidity and mortality among patients with tense ascites undergoing large-volume paracentesis, as compared with alternative treatments investigated thus far. (HEPATOLOGY 2011.).
Copyright © 2011 American Association for the Study of Liver Diseases.