Z Gastroenterol 2020; 58(05): e103-e104
DOI: 10.1055/s-0040-1710750
Hepatologie

Use of human albumin in a large “real-life” single-center cohort of patients with decompensated advanced chronic liver disease

L Balcar
1   Medical University of Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Vienna, Austria
2   Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
,
G Semmler
1   Medical University of Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Vienna, Austria
2   Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
,
B Simbrunner
1   Medical University of Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Vienna, Austria
2   Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
,
D Bauer
1   Medical University of Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Vienna, Austria
2   Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
,
P Schwabl
1   Medical University of Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Vienna, Austria
2   Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
,
T Bucsics
1   Medical University of Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Vienna, Austria
2   Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
,
R Paternostro
1   Medical University of Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Vienna, Austria
2   Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
,
M Trauner
1   Medical University of Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Vienna, Austria
,
M Mandorfer
1   Medical University of Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Vienna, Austria
2   Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
,
B Scheiner
1   Medical University of Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Vienna, Austria
2   Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
,
T Reiberger
1   Medical University of Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Vienna, Austria
2   Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
› Author Affiliations
 

Background Human albumin (HA) is increasingly recognized as disease-modifying drug in patients with advanced chronic liver disease (ACLD). However, HA is also used as a colloid for non-liver-related causes, but due to high costs, its use should be restricted to evidence-based indications. Thus, we evaluated the indications for HA use in a real-life patient population.

Methods Indications for HA use in patients treated at the Vienna General Hospital between Q3/2014 and Q1/2018 were retrospectively evaluated. Patient characteristics, laboratory data were extracted from medical records.

Results 491 patients (male: 318, 65 %) - including 287 ACLD patients (male: 211, 74 %) - received HA within the study period. The main indications for HA use were: paracentesis (n = 193, 39 %), hypoalbuminemia (n = 142, 29 %, accompanied by edema in 47 %), acute kidney injury (AKI, n = 69, 14 %), spontaneous bacterial peritonitis (SBP, n = 54, 11 %), nephrotic syndrome/other chronic renal diseases (n = 22, 4 %), hypotension/hypovolemia (n = 10, 2 %) or unknown (n = 1, 1 %). Next, ACLD patients were analyzed in more detail: Mean age was 59 ± 11 years and alcohol (n = 141, 49 %) and viral hepatitis (n = 50, 17 %) were the main etiologies of liver disease. Mean MELD at albumin infusion was 21 ± 7 points. Overall, 1017 indications for HA administration were identified including large-volume paracentesis (n = 896, 88 %), HRS-AKI (n = 70, 7 %) and SBP (n = 51, 5 %). While 767 of 896 (86 %) patients undergoing large volume paracentesis (LVP) were receiving guideline-conform doses of albumin (i.e. 8g/L ascites removed), only 25/70 (36 %) and 13/51 (25 %) patients received the recommended doses of albumin for HRS-AKI (i.e. 1g/kg bodyweight on day 1 and 2, maximum of 100 g/d) and for SBP (i.e. 1.5 g/kg bodyweight on day 1 and 1g/kg on day 3), respectively.

Conclusions HA is frequently used in clinical practice, also in non-ACLD patients. However, it is often underdosed for well-established indications in ACLD patients, in particular HRS-AKI and SBP.



Publication History

Article published online:
26 May 2020

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