Efficacy and safety of albumin infusion for overt hepatic encephalopathy: A systematic review and meta-analysis

Background and Aims: The efficacy and safety of albumin infusion for treatment and prevention of overt hepatic encephalopathy (OHE) among cirrhosis patients remained controversial. We performed a system-atic review and meta-analysis to evaluate the benefit of albumin infusion for the treatment and preven-tion of OHE. Methods: We performed a systematic search of 4 electronic databases up to 31st January 2021. The pri-mary outcome was the resolution of OHE. Secondary outcomes were inpatient mortality and albumin-associated adverse events. We assessed the pooled odds' risk, pooled mean differences, 95% confidence interval and heterogeneity using Review Manager Version 5.3. Results: A total of 12 studies (2,087 subjects) were identified. Among cirrhosis patients with OHE, albu-min infusion was associated with a lower pooled risk of OHE (OR = 0.43, 95%CI: 0.27, 0.68; I 2 = 0%). Among patients without baseline OHE, albumin infusion was associated with a lower pooled risk of developing OHE (OR = 0.53, 95%CI: 0.32, 0.86; I 2 = 62%). Albumin infusion was associated with a lower pooled risk of inpatient mortality (OR = 0.36, 95%CI: 0.21, 0.60; I 2 = 0%). Conclusion: Well-powered randomized trials are required to confirm the benefits of albumin infusion for the prevention and treatment of overt hepatic encephalopathy among decompensated cirrhosis patients. (c) 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.