Albumin shows uncertain clinical effects in liver cirrhosis infections

Cirrhosis, Infections, and the Albumin Debate

Human albumin administration in adults with liver cirrhosis and bacterial infections yields highly uncertain clinical effects, according to evidence updated to August 20, 2025.

Researchers evaluating 11 randomized studies involving 1,273 adult participants found that current data remain insufficient to confirm whether intravenous albumin reduces mortality, prevents kidney damage, or alters the frequency of serious complications compared to no intervention or alternative intravenous fluids.

Assessing Outcomes Against No Treatment

Cirrhosis involves progressive scarring of the liver over time, which can trigger severe complications such as fluid accumulation in the abdomen, impaired brain function, and jaundice. Patients with advanced liver damage face a heightened vulnerability to bacterial infections, which frequently drive clinical deterioration and death. To test whether human albumin—a primary blood protein—improves outcomes when administered alongside antibiotics, investigators analyzed eight trials comparing intravenous albumin against no treatment.

The resulting analysis revealed that researchers are very uncertain regarding the effects of albumin on all-cause mortality, unwanted serious events, and specific complications of cirrhosis.

The available data leave significant ambiguity over whether albumin reduces kidney damage or lowers the risk of septic shock, defined as dangerously low blood pressure resulting from severe infection. None of the evaluated trials reported patient well-being data.

Weighing Albumin Against Alternative Fluids

Beyond comparisons with no treatment, three clinical trials examined albumin against alternative intravenous fluids, such as saline solutions or synthetic colloids. These studies included patients with infections spanning various bodily sites, including spontaneous bacterial peritonitis—an infection of the membrane lining the inside of the abdomen—as well as pulmonary and urinary tract infections.

Across these comparative trials, findings indicate persistent uncertainty. Investigators remain unsure whether albumin influences all-cause mortality or kidney damage, or whether the protein solution increases serious unwanted events. Evidence regarding whether albumin reduces septic shock compared to other fluids is similarly inconclusive. The analyzed studies did not capture data concerning patient well-being or broader complications of cirrhosis.

Methodological Flaws and the Path Forward

The certainty of the current evidence is rated as low to very low due to structural flaws in trial design and execution, alongside a general lack of sufficient data for meaningful outcome analysis. Ten of the reviewed trials operated either free from for-profit support or without reported funding sources, while one trial declared partial private support involving the delivery of albumin vials.

To address these gaps, investigators concluded that larger, blinded clinical trials are necessary. Future research must encompass pediatric populations, rigorously investigate differences between various types of albumin products, and establish direct performance comparisons against alternative intravenous fluids.