Efficacy and safety of albumin for the treatment of hepatic encephalopathy: an updated systematic review and meta-analysis of randomized controlled trials.
Farhan Murtaza, Midhun Mathew, Oluwaseun Fagbamila, Sachin Subramani, Simran Nimal, Veeramachaneni Naga Nyshita, Vishnu Priya, Abu Talha Sany, Yamanth Kumar, Laura Cicani, Muhammad Ehsan, Kamal Kandel
Author Information
Farhan Murtaza: Department of Medicine, Allama Iqbal Medical College.
Midhun Mathew: Department of Medicine, Pennsylvania Hospital, Philadelphia, PA.
Oluwaseun Fagbamila: Saint Elizabeth Health Care Center, Mississauga, ON, Canada.
Sachin Subramani: Department of Medicine, ESIC Medical College and Hospital, Gulbarga.
Simran Nimal: Department of Medicine, BJ Medical College, Pune.
Veeramachaneni Naga Nyshita: Department of Medicine, Andhra Medical College, Visakhapatnam.
Vishnu Priya: Department of Medicine, Government Kilpauk Medical College, Chennai, India.
Abu Talha Sany: Department of Medicine, Brahmanbaria Medical College & Hospital, Brahmanbaria, Bangladesh.
Yamanth Kumar: Department of Medicine, Government Kilpauk Medical College, Chennai, India.
Laura Cicani: Department of Medicine, International University of Health Sciences, Las Vegas, NV.
Muhammad Ehsan: Department of Medicine, King Edward Medical University, Lahore, Pakistan.
Kamal Kandel: Kathmandu University, Dhulikhel, Nepal.
Background: Albumin acts as a scavenger of reactive oxygen species and an inhibitor of inflammatory processes that underlie hepatic encephalopathy (HE). However, the role of albumin in hepatic encephalopathy is not well-established. The authors performed this meta-analysis to evaluate the efficacy and safety of albumin in the management of hepatic encephalopathy. Methods: The authors carried out an extensive search across multiple databases, including MEDLINE (via PubMed), Embase, CENTRAL, and various trial registries, to identify randomized controlled trials (RCTs) evaluating the impact of albumin administration in HE. The authors used a random-effects model for analyses and presented dichotomous outcomes and continuous outcomes as relative risk and mean difference, along with corresponding 95% CIs, respectively. Heterogeneity was assessed using both the I index and �� test. Results: Our meta-analysis included 4 RCTs involving 306 patients. Our primary outcomes, mortality, and persistence of HE were reported by all four studies. Albumin was found to significantly decrease mortality in patients with HE [risk ratio (RR) 0.52, 95% CI 0.32-0.83; =0%]. Persistence of HE was found to be comparable between the two groups (RR 0.83, 95% CI 0.68-1.00; =24%). There was no significant difference between the albumin and control groups regarding length of hospital stay (MD -1.55, 95% CI -3.5 to 0.14; =41%), adverse events (RR 1.00, 95% CI 0.87-1.16; =0%), and severe adverse events (RR 0.89, 95% CI 0.59-1.35). Conclusion: Albumin administration in patients with hepatic encephalopathy decreases mortality but does not significantly impact the persistence of HE. Further high-quality, large-scale randomized controlled trials are needed to provide conclusive evidence.
