Liver Cirrhosis Treatment and Management

Monitoring and Assessment of Human Albumin Administration

• For hospitalized cirrhotic patients, the European Association for the Study of the Liver recommends using 50-100 g of essentially pure HA (≥96% pure) to improve circulatory and renal function, with a maximum daily dose of up to 2 g/kg.
• Treatment should be discontinued when the goal is achieved, and continued only if the effect is maintained after follow-up.
• Daily assessment of response to HA administration should be based on improvement of:
  • Clinical parameters (dyspnea, blood pressure, consciousness, peritoneal signs, and peripheral perfusion)
  • Laboratory parameters (hemoglobin value, MELD score, and hepatic function)
  • Hemodynamic trajectories

Parameters to Monitor

• Laboratory findings to assess:
  • Protein concentrations (mass or mole)
  • Albumin NC, ONC, and A/G ratio
  • Hemoglobin and hematocrit
  • Serum creatinine, bilirubin, and pH values
  • Plasma renin, aldosterone, or antidiuretic hormone concentrations
  • Colloid oncotic pressure (using Sav210 device)
• Clinical assessment of organ function and overall condition
• Outcomes of principal clinical end-points of the study

Assessment of Efficacy and Safety

• Criteria for evaluation of efficacy:
  • Hepatic encephalopathy (using Hepatic Encephalopathy Scoring Algorithm)
  • Temporal resolution of spontaneous bacterial peritonitis
  • Occurrence of compartment syndrome
  • Exclusion of acute-on-chronic liver failure after SBP resolution
• Criteria for estimation of 'responder' to treatment:
  • Resolution of systemic inflammatory response syndrome criteria
  • Exclusion of acute-on-chronic liver failure after SBP resolution
• Evaluation of safety during treatment should include:
  • Vital parameters
  • Grading of fluid administration
  • Differentiation between colloidal and crystalloid solution
  • Grading of criteria for 'rescue therapy'
  • Complications (abdominal edema, flushing sensation, and/or hyperpyrexia)
  • Estimation of transfusion needs by Hb levels
  • Grading of signs of hypovolemia both at clinical and hemodynamic levels

This quiz assesses your knowledge on the clinical practice recommendations for hospitalized cirrhotic patients, including treatment options and guidelines.