Adding IV Albumin to Lactulose Improves Outcomes in Severe Hepatic Encephalopathy

Intravenous (IV) albumin might reduce oxidative stress by decreasing levels of circulating cytokines and endotoxins (NEJM JW Hosp Med Jan 2014 and Hepatology 2013; 58:1836). A 2013 study showed that IV albumin lowered risk for 90-day mortality in patients with hepatic encephalopathy (HE; J Hepatol 2013; 59:1184). In a new trial, researchers in India randomized 120 cirrhotic patients with severe HE (mean baseline serum albumin level, 2.3 g/dL; 78% with West-Haven Grade 3 or 4 encephalopathy) to IV albumin (1.5 g/kg/day) plus lactulose or to lactulose therapy alone.

Patients who received albumin were significantly more likely than lactulose-only patients to experience complete reversal of HE within 10 days (75% vs. 53%; number needed to treat …