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Albumin is a multifunctional protein with pleiotropic activity that is produced almost exclusively in the liver. From many studies in several patient groups, it has become clear that in patients with liver disease, there is a reduction both in the quality and quantity of the circulating albumin, impacting negatively its functionality.1 Clinically, these alterations may lead to changes in oncotic pressure, immune status and the ability to deal with infection and inflammation, carrying a potential negative impact on patient outcomes. Therefore, there have been many studies in patients with liver disease for the last 50 years that have shown that albumin infusion can restore the oncotic pressure and thereby manage hypotension and oedema and finally provide volume expansion to support end organ blood flow and function. These have led to guideline-based indications for the acute or short-term use of human albumin solution for the management of patients with spontaneous bacterial peritonitis (SBP), hepatorenal syndrome and to reduce postparacentesis circulatory dysfunction after total abdominal paracentesis.1 However, infusion of human albumin solution has been found ineffective in patients with non-SBP bacterial infections, acute episodes of hepatic encephalopathy and acute decompensation of cirrhosis.2–4 More recently, the use of long-term regular albumin infusions has been explored for long-term management of patients with decompensated cirrhosis using regular infusions, the results of which are quite varied, with huge benefits observed in some and no such benefit in others.5 6 The reason for this wide variation is not clear but may relate to the selection of patients for these therapies, the dose and duration of albumin treatment and possibly the quality of albumin that is being used.