Медицинский совет (May 2020)
Role of human albumin in the management of liver cirrhosis
Abstract
Aim. To demonstrate the role of concentrated human albumin in cirrhotic patient management.The main content. Albumin has a clear place in the clinical practice of cirrhotic patients managing. The structure and functions of albumin can be impaired in patients with acute and chronic liver failure, which correlates with the severity of the disease course and can affect its outcome. Intravenous transfusions of highly concentrated (20%) human albumin are necessary to achieve a response to diuretic therapy. Plasma volume expansion should be performed by albumin transfusing after removal of ascitic fluid during a large volume paracentesis in patients with tense ascites.The administration of albumin is recommended in patients with spontaneous bacterial peritonitis; the aim: to potentiate the action of antibiotics and prevents the development of other complications, such as encephalopathy, progressive liver failure, impaired renal function. The combination of terlipressin with albumin is a first-line therapy in patients with hepatorenal syndrome-acute kidney injury (hepatorenal syndrome of type I according to the old terminology). The same combination is effective in treating another form of renal dysfunction - type II hepatorenal syndrome according to the old classification, i.e. a patient with hepatorenal syndrome does not meet the criteria for acute kidney injury. Recently, the results of a multicenter randomized parallel-group study, Answer (human Albumin for the treatmeNt of aScites in patients With hEpatic cirrhosis) were published, which showed that prolonged weekly use of human albumin contributes to control of ascites, reduces the incidence of infectious complications, episodes of encephalopathy in patients with decompensated cirrhosis. This leads to a decrease in the frequency of repeated hospitalizations, a decrease in mortality, an improvement in the quality of life, and an increase in the overall survival.
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