Acute Hemodynamics of Albumin Versus Normal Saline in Cirrhosis - Full Text View

Purpose

Cirrhosis is frequently complicated by derangement of body fluid homeostasis resulting in accumulation of large amounts of extracellular fluid in the peritoneal cavity (ascites) and interstitial tissue (edema). Studies showed that patients with cirrhosis and ascites have marked circulatory dysfunction. Albumin infusions have been used for many years in the management of patients with cirrhosis and ascites in an attempt to reduce the formation of ascites and/or improve circulatory and renal function. While some of these indications for albumin infusions are supported by the results of randomised studies, others are based on clinical experience and have not been proved in prospective investigations. Therefore, the use of albumin infusions in patients with cirrhosis is controversial. Recently, this debate has been fostered by the high cost and limited availability of albumin and the results of a meta-analysis showing that albumin administration may increase mortality in critically ill patients. In cirrhotics, there is a significant improvement in the low effective arterial blood volume, which may be important in the prevention of circulatory dysfunction and in preventing renal impairment. However, in an already fluid overload state such as that of cirrhosis, albumin infusion predisposes the individual to develop pulmonary edema. There is no study demonstrating acute effect of albumin infusion on hemodynamic parameters, in cirrhotic patients. Neither is there is data concerning comparison between albumin and normal saline. It is postulated that it may increase portal pressure thereby increasing the risk of variceal bleed. This study hypothesizes that albumin infusion might lead to alteration in portal and pulmonary hemodynamics in decompensated cirrhotic patients. Included patients of cirrhosis with ascites (based on inclusion and exclusion criteria) will undergo baseline investigations (systemic hemodynamics, pulmonary hemodynamics, portal hemodynamics). They will be randomized into two groups, each of 8. One group will receive infusion of 100 ml 20% albumin over 3 hours, and the other will receive infusion of 100 ml normal saline over 3 hours. Repeat hemodynamic studies will be performed after the infusion finishes. All results will be expressed as mean ± SD or frequency (%). Comparisons will be performed by the Student's t test or with the Wilcoxon's test

Condition	Intervention
Cirrhosis Ascites	Drug: 20% Human Albumin Drug: Normal Saline


Study Type:	Interventional
Study Design:	Allocation: Randomized Intervention Model: Parallel Assignment Masking: Double Blind (Participant, Care Provider) Primary Purpose: Diagnostic
Official Title:	Acute Hemodynamic Effects of Albumin Versus Normal Saline in Patients With Cirrhosis With Ascites: A Randomized Controlled Trial

Resource links provided by NLM:

Genetics Home Reference related topics: North American Indian childhood cirrhosis

MedlinePlus related topics: Cirrhosis

U.S. FDA Resources

Further study details as provided by Govind Ballabh Pant Hospital:

Primary Outcome Measures:

Immediate change in mean arterial pressure, cardiac output, systemic vascular resistance, pulmonary capillary wedge pressure, pulmonary vascular resistance and HVPG on infusion of 100 ml of 20% albumin or normal saline in decompensated cirrhotics [ Time Frame: Immediately after 3 hours of infusion ]

Secondary Outcome Measures:

Adverse effects to the drug (albumin or normal saline) [ Time Frame: During or immediately after infusion ]


Estimated Enrollment:	16
Study Start Date:	May 2007
Estimated Study Completion Date:	December 2008
Estimated Primary Completion Date:	December 2008 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Active Comparator: I Infusion of 100 mL of 20% Albumin	Drug: 20% Human Albumin Infusion of 100 mL of 20% Albumin over 3 hours
Placebo Comparator: II 100 mL Normal Saline	Drug: Normal Saline Infusion of 100 mL of Normal Saline

Eligibility


Ages Eligible for Study:	12 Years to 75 Years (Child, Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Patients with cirrhosis with ascites admitted to the GE ward
They require intravenous albumin therapy, for the management of their cirrhotic ascites
Their serum albumin <2.8 g/dL

Exclusion Criteria:

Cirrhotics without ascites
Acute on chronic liver failure
Serum bilirubin >3 mg/dL
Hepatorenal syndrome
Patients suffering from heart disease, history of allergy to albumin, pregnant women, hypertension, chronic nephritis
Lack of informed written consent

Contacts and Locations

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00511394

Locations


India
Department of Gastroenterology, G B Pant Hospital
New Delhi, Delhi, India, 110002

Sponsors and Collaborators

Govind Ballabh Pant Hospital

Investigators


Principal Investigator:	Shiv K Sarin, MD, DM	Govind Ballabh Pant Hospital

More Information


Responsible Party:	Dr S K Sarin, G B Pant Hospital
ClinicalTrials.gov Identifier:	NCT00511394 History of Changes
Other Study ID Numbers:	2007-PHT-01
Study First Received:	August 2, 2007
Last Updated:	October 14, 2008

Keywords provided by Govind Ballabh Pant Hospital:


Decompensated Cirrhosis with Ascites

Additional relevant MeSH terms:


Fibrosis Liver Cirrhosis Ascites	Pathologic Processes Liver Diseases Digestive System Diseases

ClinicalTrials.gov processed this record on July 25, 2017