Table 5.
Clinical Recommendations for the Use of Albumin to Treat Complications in Patients with Cirrhosis
| Uses | EASL 201821 | AASLD 201222 | AISF-SIMTI 201694 | CMA 201989 |
|---|---|---|---|---|
| PICD | If ≥5 L ascites removed, infuse 8 g/L albumin If ≤5 L ascites removed, infuse albumin* |
If ≥5 L ascites removed, infuse 6–8 g/L albumin If ≤5 L ascites removed, albumin infusion may not be necessary |
If ≥5 L ascites removed, infuse 6–8 g/L albumin If ≤5 L ascites removed, albumin infusion preferred due to concerns regarding the use of synthetic colloids/crystalloids* |
If ≥4 L ascites removed, infuse 4 g/L albumin |
| SBP | Day 1: 1.5 g/kg albumin, Day 3: 1 g/kg (in combination with broad spectrum antibiotics) | Day 1: Cefotaxime plus 1.5 g/kg albumin within 6 hours Day 3: 1 g/kg albumin |
Day 1: 1.5 g/kg albumin, Day 3: 1 g/kg (in combination with broad spectrum antibiotics) |
Insufficient guideline recommendations |
| HRS-1 | Days 1–2: 1 g/kg, then 20–40 g/kg/day in combination with terlipressin (1 mg/4–6 h IV bolus) | 10–20 g/kg albumin for 20 days in combination with vasoactive drugs 3 times per day (octreotide at 200 µg; or midodrine at 12.5 mg) | Days 1: 1 g/kg, then 20–40 g/kg/day in combination with vasoconstrictors, until they are withdrawn | Albumin 20–40 g/day in combination with 1 mg terlipressin every 4–6 h for 3 days, terlipressin can be increased to 2 mg after 3 days, if necessary |
| Non-SBP infections | Insufficient evidence for guideline recommendations | |||
| Long-term administration | Insufficient evidence for guideline recommendations Evidence for consideration based on the following trials published after the guidelines: Albumin at 40 g twice weekly for 2 weeks, followed by 40 g weekly for a maximum of 18 months in combination with SMT33 Albumin at 20 g twice per week in combination with SMT for up to 24 months90 |
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Note: *Dose not defined.
Abbreviations: AASLD, American Association for the Study of Liver Diseases. AISF-SIMTI, Italian Association for the Study of Liver and the Italian Society of Transfusion Medicine and Immunohaematology; CMA, Chinese Medical Association; EASL, European Association for the Study of Liver; h, hour; HRS-1, hepatorenal syndrome type-1; PICD, paracentesis-induced circulatory dysfunction; SBP, spontaneous bacterial peritonitis, SMT, standard medical treatment.