Efficacy of Albumin for Acute Encephalopathy in Patients With Cirrhosis
Efficacy of Albumin for Acute Encephalopathy in Patients With Cirrhosis
The purpose of this study is to determine whether the administration of albumin in addition
 to the standard care is effective in the treatment of an episode of hepatic encephalopathy in
 patients with cirrhosis.
Hepatic encephalopathy is a frequent complication of cirrhosis that is usually associated
 with poor prognosis. The most common presentation is an acute episode of hepatic
 encephalopathy precipitated by factors that increase the exposure of the brain to ammonia.
 Current therapies are based on measures that decrease plasma ammonia and counteract the
 effect of factors such as infection or electrolyte's disturbances. Brain edema and
 abnormalities of cerebral blood flow appear to be important. Part of the impairment of
 astrocyte function could be related to an increase of oxidative stress injury.

 In patients with cirrhosis and hepatic encephalopathy, the concentration of albumin in plasma
 is usually low. Administration of human albumin in patients with hepatorenal syndrome and
 spontaneous bacterial peritonitis has a major impact on the prognosis of these complications.
 Albumin prevents circulatory dysfunction and renal failure. The mechanisms of action may
 include the maintenance of oncotic pressure and a scavenger effect of toxic substances
 present in blood. Albumin has also shown beneficial effects in neurological injury secondary
 to stroke, probably in relation to this scavenger effect.

 The administration of intravenous albumin to patients with hepatic encephalopathy may have
 beneficial effects on the course of encephalopathy.
Inclusion Criteria:

 -  Cirrhosis of the liver

 -  Hepatic encephalopathy stage>1

 -  Completion of a standardized protocol to investigate precipitating factors

 -  Informed consent by next of keen

 Exclusion Criteria:

 -  Pregnancy

 -  Terminal liver disease (advanced liver disease and performance status 3-4 prior to the
 episode of acute encephalopathy)

 -  Need of advanced life support (mechanical ventilation, ionotropic support, dialysis)

 -  Need of albumin administration (e.g. bacterial spontaneous peritonitis)

 -  Contraindication for albumin administration (e.g. cardiac failure)