Abstract
Background and Aim: Hyponatraemia portends a poor prognosis in decompensated cirrhosis and is an independent predictor of mortality. Multiple modalities have been evaluated in the management of hyponatremia, including albumin infusion. However, the effect of albumin infusion in the resolution of hyponatremia is unclear. We conducted a systematic review to explore the available literature on the use of albumin infusion in hyponatremia. Methods: We performed a comprehensive search using MEDLINE and EMBASE for studies reporting the effectiveness of albumin infusion in the resolution of hyponatremia. All available studies on adult patients published in the English language investigating the impact of albumin infusion of any dose, administration frequency, and duration of therapy were included. The study protocol was prospectively registered (CRD42021245914) Results: The literature search yielded 1473 references after duplicate removal. Only four studies (two cohort studies, one case series and one randomized trial) satisfied the predefined selection criteria after a full-text review. While hyponatremia was clearly defined as serum sodium <130meEq/L in all studies, only one study explicitly defined hyponatremia resolution (serum sodium >135mEq/L). No differentiation was made between the type of hyponatremia. The strength of albumin infusion used was 5 % and 20%. All but one study reported significant improvement of hyponatremia with albumin infusion. A subgroup analysis showed albumin infusion improved 30-day survival (Odds ratio 0.43, 95% CI 0.25-0.74, I2=0.) No studies reported adverse events or impact of concomitant associations ( diuretic withawal, lactulose use, sepsis). Conclusion: The available evidence for the use of albumin infusion for the resolution of hyponatremia is insufficient. Large prospective studies with pre-defined selection criteria and endpoints are required to generate the evidence
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