Universität zu Köln

Kuetting, Fabian, Schubert, Jens, Franklin, Jeremy ORCID: 0000-0003-1536-0925, Bowe, Andrea, Hoffmann, Vera, Demir, Muenevver, Pelc, Agnes, Nierhoff, Dirk, Toex, Ulrich and Steffen, Hans-Michael (2017). Insufficient evidence of benefit regarding mortality due to albumin substitution in HCC-free cirrhotic patients undergoing large volume paracentesis. J. Gastroenterol. Hepatol., 32 (2). S. 327 - 339. HOBOKEN: WILEY. ISSN 1440-1746

Full text not available from this repository.

Abstract

BackgroundCurrent guidelines for clinical practice recommend the infusion of human albumin after large volume paracentesis. After inspecting the current evidence behind this recommendation, we decided to conduct a systematic review and meta-analysis in order to address the effect of albumin on mortality and morbidity in the context of large volume paracentesis. MethodsWe performed a comprehensive search of large databases and abstract books of conference proceedings up to March 15th 2016 for randomized controlled trials, testing the infusion of human albumin against alternatives (vs no treatment, vs plasma expanders; vs vasoconstrictors) in HCC-free patients suffering from cirrhosis. We analyzed these trials with regard to mortality, changes in plasma renin activity (PRA), hyponatremia, renal impairment, recurrence of ascites with consequential re-admission into hospital and additional complications. We employed trial sequential analysis in order to calculate the number of patients required in controlled trials to be able to determine a statistically significant advantage of the administration of one agent over another with regard to mortality. ResultsWe were able to include 21 trials totaling 1277 patients. While the administration of albumin prevents a rise in PRA as well as hyponatremia, no improvement in strong clinical endpoints such as mortality could be demonstrated. Trial sequential analysis showed that at least 1550 additional patients need to be recruited into RCTs and analyzed with regard to this question in order to detect or disprove a 25% mortality effect. ConclusionsThere is insufficient evidence that the infusion of albumin after LVP significantly lowers mortality in HCC-free patients with advanced liver disease.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Kuetting, Fabian UNSPECIFIED UNSPECIFIED UNSPECIFIED Schubert, Jens UNSPECIFIED UNSPECIFIED UNSPECIFIED Franklin, Jeremy UNSPECIFIED orcid.org/0000-0003-1536-0925 UNSPECIFIED Bowe, Andrea UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoffmann, Vera UNSPECIFIED UNSPECIFIED UNSPECIFIED Demir, Muenevver UNSPECIFIED UNSPECIFIED UNSPECIFIED Pelc, Agnes UNSPECIFIED UNSPECIFIED UNSPECIFIED Nierhoff, Dirk UNSPECIFIED UNSPECIFIED UNSPECIFIED Toex, Ulrich UNSPECIFIED UNSPECIFIED UNSPECIFIED Steffen, Hans-Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-240525
DOI:	10.1111/jgh.13421
Journal or Publication Title:	J. Gastroenterol. Hepatol.
Volume:	32
Number:	2
Page Range:	S. 327 - 339
Date:	2017
Publisher:	WILEY
Place of Publication:	HOBOKEN
ISSN:	1440-1746
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language INDUCED CIRCULATORY DYSFUNCTION; TRIAL COMPARING ALBUMIN; TENSE ASCITES; INTRAVENOUS ALBUMIN; THERAPEUTIC PARACENTESIS; PREVENTION; INFUSION; TERLIPRESSIN; MIDODRINE; DEXTRAN-70 Multiple languages Gastroenterology & Hepatology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/24052