Ana Carolina Covre COAN, Vanio Livramento Junior ANTUNES, Alonzo Armani PRATA, Natália Junkes MILIOLI, Tulio L CORREA, Otavio Cosendey MARTINS, Pedro ROMEIRO, Elísio Santos BULHÕES JÚNIOR, André Milani REIS, Matheus Vanzin FERNANDES
Hepatology Forum - 2026;7(1):4-13
Background and Aim: Hepatic encephalopathy (HE) is a complication of cirrhosis and one of the most important manifestations of this disease. Intravenous albumin may have the potential to mitigate oxidative stress injury inherent to the pathogenesis of HE. Our study aims to evaluate the efficacy and safety of albumin for the treatment of HE. Materials and Methods: We performed a systematic review and meta-analysis using the PubMed, Embase, and Cochrane databases. We searched for randomized controlled trials (RCTs) comparing albumin to placebo in patients with HE and decompensated cirrhosis. The outcomes were mortality and clinical improvement of HE. The odds ratio (OR) was used for binary outcomes and the mean difference (MD) for continuous outcomes with their respective 95% confidence interval (CI). Heterogeneity was assessed using the Cochran Q test and I² statistics. Trial sequential analysis (TSA) was performed for all outcomes. Results: This study included four RCTs, amounting to 306 patients. There was a significant difference favoring albumin use for mortality (OR 0.44; 95% CI 0.24 to 0.79; p=0.007; I2=0%) and for HE improvement (OR 2.41; 95% CI 1.22 to 4.75, p=0.011; I2=34.9%) compared to placebo. There was no significant difference in ammonia levels (p=0.580), liver transplantation (p=0.732), and significant adverse events (AE) rate (p=0.586). TSA revealed that the pooled effect is statistically significant for mortality reduction with albumin use; however, regarding sample size, the result is not definitive. Conclusion: In patients with HE, intravenous albumin leads to HE improvement and reduced mortality, without an increase in AE rates. However, the TSA indicated that further studies are required to draw precise evidence regarding the use of albumin to reduce mortality in this population.
