On-treatment serum albumin level can guide long-term treatment in patients with cirrhosis and uncomplicated ascites

Vito Di Marco, Vincenza Calvaruso, Loredana Simone, Nicola Maurizio Castellaneta, Chiara Mazzarelli, Agnese Antognoli, Vincenzo Sangiovanni, Vincenza Calvaruso, Ferdinando A. Giannone, Alida Andrealli, Maria Colpani, Maurizio Baldassarre, Paolo Angeli, Mario Angelico, Daniela Maiorca, Giacomo Zaccherini, Annalisa Tortora, Elisa Negri, Chiara Pasquale, Silvia NardelliCarmelina Loguercio, Fabio Levantesi, Sergio Boccia, Agostino Rizzotto, Marta Cavallin, Salvatore Piano, Federica Fidone, Alessandra Pecchioli, Alessandro Risso, Josè Petruzzi, Giovanni Parrella, Manuel Tufoni, Stefania Gioia, Marcello Dallio, Carlo Alessandria, Pietro Leo, Tommaso Gabbani, Maria Guarino, Andrea Roncadori, Alba Kostandini, Daniela Campion, Arianna Lanzi, Maria Marsico, Marianna Zappimbulso, Elga Neri, Fabio Pugliese, Giovanni Raimondo, Piera Rossi, Gianluca Svegliati-Baroni, Roberto Bringiotti, Francesco De Leonardis, Giovanni Perricone, Francesco Auriemma, Marco Marzioni, Anna Visani, Francesca Capretti, Giorgio M. Saracco, Antonio Gasbarrini, Giorgio Ballardini Natascia Celli, Francesco G. Foschi, Lucia Cesarini, Silvano Fasolato, Antonietta Sticca, Marcello Vangeli, Marco Domenicali, Sara Massironi, Raffaele Cozzolongo, Irene Cacciola, Maria Rendina, Filomena Morisco, Raffaella Viganò, Paolo Caraceni, Aldo Airoldi, Pierluigi Toniutto, Stefano Fagiuoli, Gianfranco Elia, Giacomo Laffi, Francesco Salerno, Antonio Mastroianni, Sergio Neri, Manuela Merli, Oliviero Riggio, Rosanna De Marco, Nicola Caporaso, Alberto B. Alberti, Mauro Bernardi, Loredana Prestianni, Alessandra Galioto, Dario Conte, Giulia Magini, Alessandro Federico, Federica Mirici Cappa, Chiara Elia, Riccardo Guarisco

Research output: Contribution to journalArticlepeer-review

Abstract

Background & Aims: The ANSWER study reported that long-term albumin administration in patients with cirrhosis and uncomplicated ascites improves survival. During treatment, serum albumin increased within a month and remained stable thereafter. In this post hoc analysis, we aimed to determine whether on-treatment serum albumin levels could guide therapy. Methods: Logistic regression was used to assess the association between baseline serum albumin and mortality, as well as to determine on-treatment factors associated with mortality and to predict the achievement of a given on-treatment serum albumin level. Survival was assessed by Kaplan-Meier estimates and second-order polynomial regression. Patients whose on-treatment serum albumin remained below normal were compared with a subset of patients from the control arm matched by principal score. Results: Baseline serum albumin was closely associated with 18-month mortality in untreated patients; albumin treatment almost effaced this relationship. On-treatment serum albumin and MELD-Na at month 1 were the sole independent variables associated with mortality. Second-order polynomial regression revealed that survival improved in parallel with increased 1-month on-treatment serum albumin. Kaplan-Meier estimations showed that any value of 1-month on-treatment serum albumin (0.1 g/dl intervals) in the range 2.5–4.5 g/dl discriminated patient survival. In the normal range of serum albumin, the best discriminant value was 4.0 g/dl. Compared to untreated patients, survival even improved in patients whose on-treatment serum albumin remained below normal. Conclusion: Baseline serum albumin per se should not guide the decision to start albumin therapy. Conversely, 1-month on-treatment serum albumin levels are strongly associated with outcomes and could guide the use of albumin – 4.0 g/dl being the target threshold. However, even patients whose serum albumin remains below normal benefit from long-term albumin administration. Lay summary: The ANSWER study has shown that long-term albumin administration improves survival and prevents the occurrence of major complications in patients with cirrhosis and ascites. This study shows that the achievement of these beneficial effects is related to a significant increase in serum albumin concentration. Even though the best results follow the achievement of a serum albumin concentration of 4 g/dl, a survival benefit is also achieved in patients who fail to normalise serum albumin.
Original languageEnglish
Pages (from-to)340-349
Number of pages10
JournalJournal of Hepatology
Volume74
Publication statusPublished - 2020

All Science Journal Classification (ASJC) codes

  • Hepatology

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