Long-term albumin treatment for decompensated cirrhosis in Italy: A propensity score-matched, retrospective, real-world chart analysis

Introduction and Objectives International guidelines recommend short-term albumin in specific acute conditions related to decompensated cirrhosis. Recent data from the large-scale ANSWER trial suggest long-term albumin (LTA) can be beneficial in selected patients. This study compared clinical outcomes in patients with decompensated cirrhosis in Italy, treated with LTA plus standard of care (SOC; LTA cohort) versus SOC alone (non-LTA cohort). Materials and Methods A retrospective chart analysis assessed patients with decompensated cirrhosis and ascites, receiving LTA (regular albumin, ≥40 g per infusion per week) plus SOC (albumin administered for acute complications) versus SOC alone. Propensity score matching was used to balance the cohorts. The primary endpoint was the incidence of therapeutic paracentesis. Results Overall, 311 charts were screened; 125 matched pairs in the LTA and non-LTA cohorts were analyzed. The incidence per patient per year of therapeutic paracentesis procedures was significantly reduced in the LTA cohort versus the non-LTA cohort (-47.8 %; p < 0.001). The incidence per patient per year of refractory ascites (-44.2 %; p = 0.018), spontaneous bacterial peritonitis (-52.7 %; p = 0.009), and hepatorenal syndrome (-62.6 %; p = 0.003), as well as duration of hospitalization per patient per year for cirrhosis-related complications (-35.0 %; p = 0.015), were also significantly reduced in the LTA cohort versus the non-LTA cohort. There were no significant differences between cohorts in the incidence per patient per year of hospital admissions for cirrhosis-related complications (-24.6 %; p = 0.050) and hepatic encephalopathy (-13.1 %; p = 0.605). Conclusions This real-world study provides evidence that LTA can improve the care of patients with decompensated cirrhosis and may reduce related healthcare burden.