Effects of Albumin on Survival after a Hepatic Encephalopathy Episode: Randomized Double-Blind Trial and Meta-Analysis.

Abstract

No therapies have been proven to increase survival after a hepatic encephalopathy (HE) episode. We hypothesize that two doses of albumin could improve 90-day survival rates after a HE episode.

METHODS:

(1) A randomized double-blind, placebo-controlled trial (BETA) was conducted in 12 hospitals. The effect of albumin (1.5 g/kg at baseline and 1 g/kg on day 3) on 90-day survival rates after a HE episode grade II or higher was evaluated. (2) A meta-analysis of individual patient's data for survival including two clinical trials (BETA and ALFAE) was performed.

RESULTS:

In total, 82 patients were included. Albumin failed to increase the 90-day transplant-free survival (91.9% vs. 80.5%, p = 0.3). A competing risk analysis was performed, observing a 90-day cumulative incidence of death of 9% in the albumin group vs. 20% in the placebo (p = 0.1). The meta-analysis showed a benefit in the albumin group, with a lower rate of clinical events (death or liver transplant) than patients in the placebo (HR, 0.44; 95% CI, 0.21-0.82), when analyzed by a competing risk analysis (90-days mortality rate of 11% in the albumin group vs. 30% in the placebo, p = 0.02).

CONCLUSIONS:

Repeated doses of albumin might be beneficial for patient's survival as an add-on therapy after an HE episode, but an adequately powered trial is needed.

• Authors: Meritxell Ventura-Cots, Macarena Simón-Talero, Maria Poca, Xavier Ariza, Helena Masnou, Jordi Sanchez, Elba Llop, Núria Cañete, Marta Martín-Llahí, Alberto Amador, Javier Martínez, Ana Clemente-Sanchez, Angela Puente, Maria Torrens, Edilmar Alvarado-Tapias, Laura Napoleone, Mireia Miquel-Planas, Alba Ardèvol, Meritxell Casas Rodrigo, Jose Luís Calleja, Cristina Solé, German Soriano, Joan Genescà
• Journal: Journal of clinical medicine (J Clin Med) Vol. 10 Issue 21 (Oct 23 2021) ISSN: 2077-0383 [Print] Switzerland
• PMID: 34768404 (Publication Type: Journal Article)