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Academic Journal of Medicine & Health Sciences, 2026, 7(1); doi: 10.25236/AJMHS.2026.070108.

Re-evaluation of Human Albumin Use in Acute Decompensation of Cirrhosis: From Prescription Practices to Precision Medicine

Author(s)

Rong Bian1, Yuanyuan Qian1,2, Huinan Chen1, Qingwei Zhou1

Corresponding Author:
Rong Bian
Affiliation(s)

1Zhuji People's Hospital of Zhejiang Province, Shaoxing, China

2Zhejiang Chinese Medical University, Hangzhou, China

Abstract

This article systematically examines the clinical application status and advancements of human albumin in acute decompensation of cirrhosis. Analysis of prescription audit data from a regional healthcare system demonstrates substantial improvement in the standardization of human albumin utilization in clinical practice. The paper elaborates on the biological characteristics of human albumin, including its roles in acute decompensation of cirrhosis. It comprehensively reviews evidence-based medical data supporting its use in preventing post-paracentesis circulatory dysfunction, treating spontaneous bacterial peritonitis, and managing hepatorenal syndrome. Based on recent research developments and clinical guidelines, standardized application recommendations are proposed, emphasizing strict indication criteria guided by evidence-based medicine to avoid inappropriate use. Finally, the direction for developing personalized precision therapy with human albumin is discussed.

Keywords

Human albumin; Acute decompensation of cirrhosis; Clinical application

Cite This Paper

Rong Bian, Yuanyuan Qian, Huinan Chen, Qingwei Zhou. Re-evaluation of Human Albumin Use in Acute Decompensation of Cirrhosis: From Prescription Practices to Precision Medicine. Academic Journal of Medicine & Health Sciences (2026), Vol. 7, Issue 1: 56-60. https://doi.org/10.25236/AJMHS.2026.070108.

References

[1] D'Amico G, Perricone G. Unanswered questions for non-acute (NAD) and acute (AD) decompensation in cirrhosis. J Hepatol. 2024;81(4):e165-e167.

[2] Trebicka J, Garcia-Tsao G. Controversies regarding albumin therapy in cirrhosis. Hepatology (Baltimore, Md) 2023; 81: 288.

[3] D'Amico G, Bernardi M, Angeli P. Towards a new definition of decompensated cirrhosis. J Hepatol. 2022 Jan;76(1):202-207.

[4] Moreau R, Jalan R, Gines P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology. 2013;144(7):1426-1437.e14379.

[5] Casulleras M, Flores-Costa R, Duran-Güell M, et al. Albumin internalizes and inhibits endosomal TLR signaling in leukocytes from patients with decompensated cirrhosis. Sci Transl Med. 2020;12(566):eaax5135.

[6] Sugio S, Kashima A, Mochizuki S, et al. Crystal structure of human serum albumin at 2.5 A resolution. Protein Eng 1999; 12: 439–446.

[7] Fasano M, Curry S, Terreno E, et al. The extraordinary ligand binding properties of human serum albumin. IUBMB Life. 2005;57(12):787-796.

[8] Bhattacharya AA, Grüne T, Curry S. Crystallographic analysis reveals common modes of binding of medium and long-chain fatty acids to human serum albumin. J Mol Biol. 2000;303(5):721-732.

[9] Gounden V, Vashisht R, Jialal I. Hypoalbuminemia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 28, 2023.

[10] Rabbani G, Ahn SN. Structure, enzymatic activities, glycation and therapeutic potential of human serum albumin: A natural cargo. Int J Biol Macromol. 2019;123:979-990.

[11] Di Giuseppe D, Priora R, Coppo L, et al. The control of hyperhomocysteinemia through thiol exchange mechanisms by mesna. Amino Acids 2014; 46: 429–439.

[12] Manjushree M , Revanasiddappa H D. Interpretation of the binding interaction between bupropion hydrochloride with human serum albumin: A collective spectroscopic and computational approach. Spectrochim Acta A Mol Biomol Spectrosc. 2019;209:264-273.

[13] Jagdish RK, Maras JS, Sarin SK. Albumin in Advanced Liver Diseases: The Good and Bad of a Drug!. Hepatology. 2021;74(5):2848-2862.

[14] Das S, Maras JS, Hussain MS, et al. Hyperoxidized albumin modulates neutrophils to induce oxidative stress and inflammation in severe alcoholic hepatitis. Hepatology. 2017;65(2):631-646.

[15] Pagano D, Toniutto P, Burra P, et al. Perioperative administration of albumin in adult patients undergoing liver transplantation: A systematic review. Dig Liver Dis. 2025;57(4):819-826.

[16] Carvalho JR, Verdelho Machado M. New Insights About Albumin and Liver Disease. Ann Hepatol. 2018;17(4):547-560. 

[17] Bernardi M, Ricci CS, Zaccherini G. Role of human albumin in the management of complications of liver cirrhosis. J Clin Exp Hepatol. 2014;4(4):302-311.

[18] Engelmann C, Clària J, Szabo G, et al. Pathophysiology of decompensated cirrhosis: Portal hypertension, circulatory dysfunction, inflammation, metabolism and mitochondrial dysfunction. J Hepatol. 2021;75 Suppl 1(Suppl 1):S49-S66.

[19] Trebicka J, Hernaez R, Shawcross DL, et al. Recent advances in the prevention and treatment of decompensated cirrhosis and acute-on-chronic liver failure (ACLF) and the role of biomarkers. Gut. 2024;73(6):1015-1024. 

[20]Arroyo V, Angeli P, Moreau R, et al. The systemic inflammation hypothesis: Towards a new paradigm of acute decompensation and multiorgan failure in cirrhosis. J Hepatol. 2021 Mar;74(3):670-685.

[21] Caraceni P, Riggi, et al.sated cirrhosis (ANSWER): an open-label randomised trial. Lancet 2018; 391: 2417–2429.

[22] Ashour AA, Atta MA, Sadek KW, et al. Albumin administration in patients with decompensated liver cirrhosis: a meta-analytic update. Eur J Gastroenterol Hepatol. 2021;33(4):479-486.

[23] Abraldes JG, Caraceni P, Ghabril M, et al. Update in the Treatment of the Complications of Cirrhosis. Clin Gastroenterol Hepatol. 2023;21(8):2100-2109.

[24] Caraceni P, Pavesi M, Baldassarre M, et al. The use of human albumin in patients with cirrhosis: a European survey. Expert Rev Gastroenterol Hepatol 2018; 12: 625–632.

[25] Caraceni P, O'Brien A, Gines P. Long-term albumin treatment in patients with cirrhosis and ascites. J Hepatol. 2022;76(6):1306-1317.

[26] Ahmed A, Singla S, Singla B, et al. Efficacy of Human Albumin Infusion in Advanced Cirrhosis and Acute-on-Chronic Liver Failure: Implications for Renal Protection and Oncologic Outcomes. Cureus. 2025;17(9):e93157.

[27] Di Pascoli M, Fasolato S, Piano S, et al. Long-term administration of human albumin improves survival in patients with cirrhosis and refractory ascites. Liver Int. 2019;39(1):98-105.

[28] Ginès P, Solà E, Angeli P, et al. Hepatorenal syndrome. Nat Rev Dis Primers. 2018;4(1):23.