The use of human albumin in patients with cirrhosis: a European survey

ABSTRACT

Background: The administration of human albumin (HA) in patients with decompensated cirrhosis is still debated. The European Foundation for the Study of Chronic Liver Failure (EF-CLIF) promoted an online survey to assess its use across Europe.

Methods: Hepatologists were invited to participate to an electronic questionnaire based on multiple-choice questions divided in 6 different areas. A descriptive statistical analysis was performed to analyze the responses.

Results: One hundred-one hepatologists (36% non-EF-CLIF member), belonging to 86 centers (25% non-academic hospitals) completed the survey. The vast majority of participants prescribe HA for the evidence-based indications supported by international guidelines, while a proportion of them consider HA administration useful for other complications currently not supported by solid scientific evidence. Participants show a good level of knowledge about the non-oncotic properties of the molecule, while HA prescription does not appear to be restricted by health authorities in most centers, at least for the evidence-based indications.

Conclusions: The present survey indicates that hepatologists across Europe present adherence to international guidelines and highlights the areas where solid scientific data are awaited to achieve a more appropriate HA prescription in patients with decompensated cirrhosis.

KEYWORDS:

• Cirrhosis
• complication of cirrhosis
• human albumin
• non-oncotic properties
• oncotic properties
• survey

Authors’ contribution

All the authors contributed to the conception and design of the study, analysis and interpretation of the data. P.C. drafted the manuscript and all the others revised it for critically for intellectual content.

Acknowledgments

The survey was supported by an unrestricted grant to EF-CLIF by Grifols S.A., Spain, who was not involved in the study design, collection, analysis, and interpretation of data, writing the manuscript and in the decision to submit the manuscript for publication.

Participants to the ALBUCIR survey: Thomas Keiberger, Markus Peck-Radosavljevic, Rudolf Stauber (Austria); Stefan Bourgeois, Thierry Gustot, Wim Laleman, Frederik Nevens, Dirk Sprengers, Hans Van Vlierberghe, Xavier Verhelst (Belgium); Jan Sperl (Czech Republic); Flemming Bendtsen, Henning Grønbæk, Aleksander Krag, Søren Møller, Fin Stolze Larsen (Denmark); Vadim Brjalin (Estonia); Roland Amathieu, Francois Durand, Philippe Mathurin, Faouzi Saliba, Dominique Valla (France); Erwin Biecker, Tony Bruns, Cornelius Engelmann, Iyad Kabar, Stephanie Klein, Daniel Markwardt, Jonel Trebicka, Alexander Zipprich (Germany); Aiden McCormick (Ireland); Carlo Alessandria, Paolo Angeli, Giorgio Ballardini, Raffaele Bruno, Agostino Colli, Raffaele Cozzolongo, Marco Distefano, Alessandro Federico, Francesco Giuseppe Foschi, Edoardo Giovanni Giannini, Fabio Levantesi, Marco Marzioni, Marco Massari, Manuela Merli, Claudio Puoti, Roberto Giulio Romanelli, Francesco Salerno, Massimo Siciliano, Mariarosa Tamè, Pierluigi Toniutto (Italy); Ieva Tolmane (Latvia); Minneke Coenraad (Netherlands); Damian Piotrowski (Poland); Maria Banza, Armando Carvalho, José Presa Ramos, Susana Rodrigues (Portugal); Horia Stefanescu (Romania); Lubomir Skladany (Slovakia); Agustin Albillos, Sonia Alonso, Maria Mercè Barenys, Jose A. Carrión, Javier Fernández, Rita García, Pere Ginès, Luis Ibáñez Samaniego, Marta Martín-Llahí, Elena Masnou Ridaura, Marta Moran, María Poca, Monica Pons, Manuel Romero-Gomez, Jordi Sánchez Delgado, Begoña Santos García de Vicuña, Elsa Solà, German Soriano, Miguel Torres, Victor Vargas, Joana Villaverde, Xavier Xiol (Spain); Christine Bernsmeier, Andreas Cerny, Andrea De Gottardi, Benedetta Terziroli (Switzerland); Osman Ozdogan (Turkey); Iryna Kobitovynch, Nataliya Virstyuk, Oleg Visrtyuk (Ukraine); Juan Acevedo, Harry Antoniades, Richard Aspinall, Ahmed Elsharkawy, Ewan Forrest, Rajiv Jalan, Adam Lawson, Stephen Ryder, Giovanni Tritto, Earl Williams, Gavin Wright (United Kingdom).

Declaration of interest

P. Caraceni has served as a paid speaker for Grifols, Baxalta, Kedrion and Octapharma; on the advisory board for Grifols; and as a scientific consultant for Kedrion. M. Bernardi has served as a paird speaker for Baxalta, PPTA Europe and Octapharma; and as an advisory board member for CLS Behring GNBH. V. Arroyo has served as a scientific advisor for Grifols and Baxalta. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was supported by an unrestricted grant by Grifols S.A., Spain. Grifols S.A., Spain, had no involvement in the study design; the collection, analysis, and interpretation of data; the writing of the manuscript or the decision to submit the manuscript for publication.