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Targeted Albumin Not Better for Hospitalized Cirrhosis Patients

MONDAY, March 8, 2021 -- For patients hospitalized with decompensated cirrhosis, albumin infusions to raise the serum albumin level to a target of 30 g per liter or higher do not improve outcomes compared with standard care, according to a study published in the March 4 issue of the New England Journal of Medicine.

Louise China, Ph.D., from the Institute for Liver and Digestive Health in London, and colleagues randomly assigned 777 hospitalized patients with decompensated cirrhosis with a serum albumin level of less than 30 g/L at enrollment to receive either targeted 20 percent human albumin solution (for up to 14 days or until discharge for shorter hospitalizations) or standard care; treatment was initiated within three days after admission. A median total infusion of albumin of 200 g per patient was administered in the targeted albumin group versus 20 g per patient in the standard-care group.

The researchers observed no significant difference between the groups in the percentage of patients with a primary end-point event (new infection, kidney dysfunction, or death between days 3 and 15 after the initiation of treatment; 29.7 percent in the targeted albumin group versus 30.2 percent in the standard-care group; adjusted odds ratio, 0.98; 95 percent confidence interval, 0.71 to 1.33; P = 0.87). Compared with the standard-care group, the targeted albumin group had more severe or life-threatening serious adverse events.

"These data strongly support both the need to abandon the use of this costly therapy, and a reappraisal of our understanding of this complex condition," a coauthor said in a statement.

One author disclosed financial ties to the pharmaceutical industry.

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