Benefit of Albumin Infusion in Hospitalized Patients With Cirrhosis and Hyponatremia: A Retrospective Cohort Study

Abstract

AIM: To investigate the optimal intravenous fluid for resuscitation of hospitalized patients with cirrhosis and hyponatremia and analyze their outcomes.

MATERIALS AND METHODS: In this retrospective cohort study, consecutive patients with hyponatremia and cirrhosis, portal hypertension, ascites, or hepatic encephalopathy receiving resuscitative fluids and hospitalized between 1/2011 and 12/2014 were analyzed. Patient characteristics, quantity and type of fluid administered, change in serum sodium, and 6-month mortality were recorded.

RESULTS: A total of 146 eligible patients were identified, of which 62% (91/146) received primarily crystalloid and 38% (55/146) primarily albumin resuscitative fluid. Those within the albumin cohort were more likely to receive diuretics (82% vs 56%, p = 0.001), have a history of refractory ascites (56% vs 21%, p < 0.001), ascites on admission (96% vs 60%, p < 0.001), higher admission body mass (81.6 kg vs 75.5 kg, p = 0.04), higher creatinine (152.9 µmol/L vs 130.8 µmol/L, p = 0.03), and higher model for end-stage liver disease (MELD) score (23.0 vs 18.9, p = 0.002) compared to those in the crystalloid cohort. Fluid selection did not impact sodium correction (p = 0.67). In multivariate analysis, receiving albumin and having higher baseline serum albumin were both associated with reduced 6-month mortality, odds ratio of 0.06 (p = 0.013) and 0.13 (p = 0.035), respectively.

CONCLUSIONS: Fluid selection in patients with cirrhosis and hyponatremia insignificantly impacted sodium correction. Albumin infusion was associated with reduced 6-month mortality. Larger prospective trials are required to investigate this relationship.