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▎The content team editor of WuXi AppTec.
The increase in infection and systemic inflammation in patients with decompensated liver cirrhosis can lead to organ dysfunction and death.
In hospitalized patients with liver cirrhosis, low albumin levels are associated with an increased risk of death.
Albumin is synthesized by liver cells, accounting for about 50%-60% of the total plasma protein, and has the functions of maintaining plasma colloidal osmotic pressure and immune regulation.
Since the 1940s, human albumin has been widely used in clinics, and albumin infusion is even considered to be an indispensable part of the clinical treatment of patients with liver cirrhosis.
However, the rationality and safety of its treatment have not reached a consistent conclusion.
A new study published in the New England Journal of Medicine provides new insights into this common treatment strategy.
The large ATTIRE trial led by scholars from University College London found that in patients with advanced liver cirrhosis, daily infusion of large amounts of albumin did not bring more significant benefits than “standard treatment”.
Screenshot source: New England Journal of Medicine principal researcher, Professor Alastair O'Brien, University College London, said, “Albumin infusion has been enthusiastically used by liver experts for 70 years, however, there has been a lack of large-scale clinical trials to support its use.
"In order to establish a better evidence base, the ATTIRE trial compared the effects of albumin compliance treatment with standard treatment on reducing infections, renal dysfunction, and death.
Standard treatment refers to the infusion of 20% human albumin solution multiple times a day, with the goal of serum albumin level reaching ≥30 g/L.
Standard treatment includes infusion of albumin to excrete ascites or improve renal failure.
According to the judgment of clinicians, each patient's standard treatment will be different, and the prescribed albumin level is much lower than the standard treatment group.Image source: The 123RF trial was carried out in 35 clinical centers in the UK, and included 777 patients hospitalized with acute decompensated cirrhosis and serum albumin levels less than 30 g/L.
Alcohol is the main cause of liver cirrhosis in 90% of patients.
These patients were randomly assigned to receive albumin compliance treatment (380 cases) or standard treatment (397 cases) for up to 14 days or until the patient was discharged.
The total amount of albumin infusion received by patients in the standard treatment group was on average 10 times that of the standard treatment group (median 200 g vs 20 g), and the serum albumin level of patients in the standard treatment group rose to ≥30 g/ in three days L, while the serum albumin level of patients in the standard treatment group remained at ≤25g/L or lower.
The results showed that within 3-15 days after the start of treatment, 29.
7% of the target treatment group had infections, renal failure or death, and this proportion was 30.
2% in the standard treatment group.
There was no significant difference between the two groups.
There was no difference in the proportion of patients with the above-mentioned events at discharge or on the 15th day.
Instead, more serious adverse events (pulmonary edema or ascites) occurred in the standard treatment group.
Of all hospitalized patients, one third (32.
3%) died within six months of starting treatment.
Therefore, the research team believes that there is no evidence that albumin treatment is beneficial.
Professor O'Brien pointed out, “Our large-scale, high-quality, randomized trials show that we need to abandon high-dose albumin infusions, and we also need to think about our understanding of this complex disease.
In addition, the high levels of these patients The mortality rate has not changed in 20 years.
We should pay attention to the prevention of liver disease, especially the prevention of excessive drinking and obesity.
The two major causes.
"New Medical Perspective Readers’ Interest Award Survey At the beginning of the new year, in order to better understand your medical and health academic information.
, Invites you to take 1 minute to fill out the questionnaire.
Participate in the survey for a chance to win prizes.
The questionnaire is anonymous, and the content of the questionnaire does not involve sensitive personal information.
The results of the survey will not be disclosed to the outside world.
They are only used for internal evaluation and serve as an important reference for the content push of this year.
The increase in infection and systemic inflammation in patients with decompensated liver cirrhosis can lead to organ dysfunction and death.
In hospitalized patients with liver cirrhosis, low albumin levels are associated with an increased risk of death.
Albumin is synthesized by liver cells, accounting for about 50%-60% of the total plasma protein, and has the functions of maintaining plasma colloidal osmotic pressure and immune regulation.
Since the 1940s, human albumin has been widely used in clinics, and albumin infusion is even considered to be an indispensable part of the clinical treatment of patients with liver cirrhosis.
However, the rationality and safety of its treatment have not reached a consistent conclusion.
A new study published in the New England Journal of Medicine provides new insights into this common treatment strategy.
The large ATTIRE trial led by scholars from University College London found that in patients with advanced liver cirrhosis, daily infusion of large amounts of albumin did not bring more significant benefits than “standard treatment”.
Screenshot source: New England Journal of Medicine principal researcher, Professor Alastair O'Brien, University College London, said, “Albumin infusion has been enthusiastically used by liver experts for 70 years, however, there has been a lack of large-scale clinical trials to support its use.
"In order to establish a better evidence base, the ATTIRE trial compared the effects of albumin compliance treatment with standard treatment on reducing infections, renal dysfunction, and death.
Standard treatment refers to the infusion of 20% human albumin solution multiple times a day, with the goal of serum albumin level reaching ≥30 g/L.
Standard treatment includes infusion of albumin to excrete ascites or improve renal failure.
According to the judgment of clinicians, each patient's standard treatment will be different, and the prescribed albumin level is much lower than the standard treatment group.Image source: The 123RF trial was carried out in 35 clinical centers in the UK, and included 777 patients hospitalized with acute decompensated cirrhosis and serum albumin levels less than 30 g/L.
Alcohol is the main cause of liver cirrhosis in 90% of patients.
These patients were randomly assigned to receive albumin compliance treatment (380 cases) or standard treatment (397 cases) for up to 14 days or until the patient was discharged.
The total amount of albumin infusion received by patients in the standard treatment group was on average 10 times that of the standard treatment group (median 200 g vs 20 g), and the serum albumin level of patients in the standard treatment group rose to ≥30 g/ in three days L, while the serum albumin level of patients in the standard treatment group remained at ≤25g/L or lower.
The results showed that within 3-15 days after the start of treatment, 29.
7% of the target treatment group had infections, renal failure or death, and this proportion was 30.
2% in the standard treatment group.
There was no significant difference between the two groups.
There was no difference in the proportion of patients with the above-mentioned events at discharge or on the 15th day.
Instead, more serious adverse events (pulmonary edema or ascites) occurred in the standard treatment group.
Of all hospitalized patients, one third (32.
3%) died within six months of starting treatment.
Therefore, the research team believes that there is no evidence that albumin treatment is beneficial.
Professor O'Brien pointed out, “Our large-scale, high-quality, randomized trials show that we need to abandon high-dose albumin infusions, and we also need to think about our understanding of this complex disease.
In addition, the high levels of these patients The mortality rate has not changed in 20 years.
We should pay attention to the prevention of liver disease, especially the prevention of excessive drinking and obesity.
The two major causes.
"New Medical Perspective Readers’ Interest Award Survey At the beginning of the new year, in order to better understand your medical and health academic information.
, Invites you to take 1 minute to fill out the questionnaire.
Participate in the survey for a chance to win prizes.
The questionnaire is anonymous, and the content of the questionnaire does not involve sensitive personal information.
The results of the survey will not be disclosed to the outside world.
They are only used for internal evaluation and serve as an important reference for the content push of this year.