EXPERIENCE IN THE USE OF HUMAN ALBUMIN IN COMPLICATIONS OF LIVER CIRRHOSIS AT HOSPITAL JUÁREZ DE MÉXICO

Abstract

Controlled clinical studies have demonstrated the benefits of albumin in decompensated cirrhotic patients with ascites, elevated creatinine, spontaneous bacterial peritonitis, refractory ascites, hepatorenal syndrome and encephalopathy, in whom the use of albumin improves not only patient survival but also expands intravascular volume, improves microcirculation, binding to numerous substances such as bile acids, nitric oxide and cytokines. However, the time of administration and the dose remains controversial. To present the experience of the administration of human albumin, the clinical and epidemiological factors associated with the success of the treatment in the different complications of hospitalized patients for decompensated cirrhosis in the Gastroenterology Department at Hospital Juárez de México from January 2019 to January 2021. A descriptive, retrospective, observational and cross-sectional study of a cohort of patients hospitalized for decompensated liver cirrhosis in the Gastroenterology Department at Hospital Juárez de México. The records of 63 patients who were administered albumin at a dose of 0.7 gr/kg of body weight were reviewed according to the type of complication, reason for admission, in such a way that epidemiological data, values ​​from laboratory studies, cause of prescription and administration results which were analyzed with measures of central tendency and percentages, obtaining Child Pugh and MELD scores. Of the population studied (N = 63); 42.8% were men (n = 27) with an average age of 57.7 years, 57.1% were women (n = 36) with an average age of 59.42 years. Regarding the etiology of liver disease, the following order was observed: alcohol-related liver disease in 42.8%, MAFLD (metabolic associated fatty liver disease) 42.8%, AIH (autoimmune hepatitis) 4.75%, PBC (primary biliary cirrhosis) 4.75% and HBV (hepatitis B virus) 4.75%. Indications for the use of albumin were spontaneous bacterial peritonitis 53.3%; an acute renal failure that does not respond to fluids, precipitated by: upper gastrointestinal bleeding in 14.2%, urinary tract infection 9.5%, alcoholic hepatitis 9.5%, liver failure due to hepatitis B virus 4%, hepatorenal syndrome 9.5%. 42.8% of the patients in the study cohort had at least one comorbidity. 77.7% of them had type 2 diabetes, 11.1% had type 2 diabetes and arterial hypertension, UC was observed in 11.1% of the population. 4.76% had Child-Pugh score A, 28.57% had Child-Pugh score B and Child Pugh score C 66.66% with an average MELD Na of 25 points. In 94.7% of the cases, effectiveness was observed in the resolution of the complication, 5.3% of the patients, despite the administration of albumin, died of septic shock (secondary to urinary tract infection n = 3, SBP n = 4 and pneumonia n = 1), these patients had Child Pugh C, mean MELD Na 32, and mean serum albumin of 1.8 mg / dl, in contrast to the respondents who had mean serum albumin of 2.62 mg / dl. Unlike what is reported in the literature, we observed that despite the lower doses administered than those recommended in the treatment guidelines, we obtained a 94.7% success rate in treated patients, observing that factors such as serum albumin value, comorbidities, Child Pugh score, MELD-NA and added infectious processes can be determining factors in the results of treatment, which raises the question of: whether the administration of albumin should be individualized according to the clinical characteristics of the patient and not a standardized dose according to their complication. Serum albumin values, the presence of comorbidities, acute infections, and high Child Pugh and MELD Na scores are independent factors that affect the results of human albumin treatment in decompensated cirrhotic patients. The authors declare that there is no conflict of interest