Intravenous albumin in treatment of acute on chronic liver failure: Can it be an option for resource constrained situation

Introduction: Acute on chronic liver failure (ACLF) is a form of acute decomposition of cirrhosis with alarmingly high mortality. This condition is seen in both hemispheres, and despite having a varied etiology and despite the differences in standard of care, the prognosis of ACLF is grave in the East and in the West alike.Since there is no definitive treatment for ACLF, other than liver transplantation, as of now, it is important to develop a safe, effective, and easily deliverable treatment for this grave condition.Materials and Methods:In all 30 ACLF patients for included in this observational clinical study, who were randomized into 2 groups. One group received intravenous albumin infusion plus standard of care, while the other group received standard of care only. Each group included 15 patients. Results: There was no difference in demographic characteristics and baseline parameters between the patients in the 2 groups. The association between investigations in different follow-ups among the 2 groups wasalso statistically not significant. At 28 days, 53.3% patients were alive in the albumin plus SOC group and 33.3% in the SOC only group. But a significant survival difference between the two groups was not observed. Hepatic encephalopathy andmulti-organ failure were the major causes of death in these 2 groups, respectively. This was also statistically not significant. Conclusion: The study established the safety of intravenous albumin infusion in ACLF patients and yielded a non-statistically significant survival benefit when intravenous albumin infusion is combined with the standard of care in ACLF.