Co-Administration of Albumin with Lactulose Reverses Hepatic Encephalopathy and Reduces Mortality in Liver Cirrhosis

A multidisciplinary team of investigators based in New Delhi randomized 120 patients with liver cirrhosis and overt hepatic encephalopathy (HE) to receive oral lactulose therapy (to reduce high blood ammonia levels that are the proximate cause of HE) or oral lactulose plus 1.5 g/kg/day of human albumin, until either complete recovery of HE or a maximum of 10 days. The primary study endpoint was complete reversal of HE; secondary endpoints included mortality and length of hospital stay.

Forty-five of 60 patients (75%) who received albumin therapy experienced complete reversal of HE, compared to 32 of 60 patients(53.3%) who received lactulose therapy alone (P = 0.03). Mortality was also significantly lower in the lactulose plus albumin group: 11 deaths (18.3%) versus 19 deaths (31.6%) in the lactulose-only group. Additionally, the mean hospital stay for patients receiving concomitant albumin therapy was more than two days shorter than for patients receiving lactulose only: 6.4 ± 3.4 versus 8.6 ± 4.3 days (P = 0.01). “The combination of lactulose plus albumin is more effective than lactulose alone for treatment of overt hepatic encephalopathy in patients with cirrhosis,” the investigators concluded.