{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T12:30:59Z","timestamp":1791635459527,"version":"4.3.4"},"reference-count":67,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2021,9,12]],"date-time":"2021-09-12T00:00:00Z","timestamp":1631404800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,9,12]],"date-time":"2021-09-12T00:00:00Z","timestamp":1631404800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:p>\n                    Human serum albumin is the most abundant plasma protein, and it regulates diverse body functions. In patients with advanced and decompensated cirrhosis, serum albumin levels are low because of a reduction in the hepatocyte mass due to disease\n                    <jats:italic toggle=\"yes\">per se<\/jats:italic>\n                    and multiple therapeutic interventions. Because of their oncotic and nononcotic properties, administration of human albumin solutions (HAS) have been found to be beneficial in patients undergoing large\u2010volume paracentesis or who have hepatorenal syndrome or spontaneous bacterial peritonitis. Albumin also improves the functionality of the immune cells and mitigates the severity and risk of infections in advanced cirrhosis. Its long\u2010term administration can modify the course of decompensated cirrhosis patients by reducing the onset of new complications, improving the quality of life, and probably providing survival benefits. There is, however, a need to rationalize the dose, duration, and frequency of albumin therapy in different liver diseases and stages of cirrhosis. In patients with acute\u2010on\u2010chronic liver failure, potentially toxic oxidized isoforms of albumin increase substantially, especially human nonmercaptalbumin and 2, and nitrosoalbumin. The role of administration of HAS in such patients is unclear. Determining whether removal of the pathological and dysfunctional albumin forms in these patients by \u201calbumin dialysis\u201d is helpful, requires additional studies. Use of albumin is not without adverse events. These mainly include allergic and transfusion reactions, volume overload, antibody formation and coagulation derangements. Considering their cost, limited availability, need for a health care setting for their administration, and potential adverse effects, judicious use of HAS in liver diseases is advocated. There is a need for new albumin molecules and economic alternatives in hepatologic practice.\n                  <\/jats:p>","DOI":"10.1002\/hep.31836","type":"journal-article","created":{"date-parts":[[2021,3,27]],"date-time":"2021-03-27T05:20:03Z","timestamp":1616822403000},"page":"2848-2862","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":115,"title":["Albumin in Advanced Liver Diseases: The Good and Bad of a Drug!"],"prefix":"10.1097","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7597-6890","authenticated-orcid":false,"given":"Rakesh Kumar","family":"Jagdish","sequence":"first","affiliation":[{"name":"Department of Hepatology,Institute of Liver and Biliary Sciences,New Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3938-362X","authenticated-orcid":false,"given":"Jaswinder Singh","family":"Maras","sequence":"additional","affiliation":[{"name":"Department of Molecular and Cellular Medicine,Institute of Liver and Biliary Sciences,New Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0544-5610","authenticated-orcid":false,"given":"Shiv Kumar","family":"Sarin","sequence":"additional","affiliation":[{"name":"Department of Hepatology,Institute of Liver and Biliary Sciences,New Delhi,India"},{"name":"Department of Molecular and Cellular Medicine,Institute of Liver and Biliary Sciences,New Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,9,12]]},"reference":[{"key":"hep31836-bib-0001-20250824","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1093\/protein\/12.6.439","article-title":"Crystal structure of human serum albumin at 2.5 a resolution","volume":"12","year":"1999","journal-title":"Protein Eng"},{"key":"hep31836-bib-0002-20250824","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1136\/gutjnl-2019-318843","article-title":"Albumin in decompensated cirrhosis: new concepts and perspectives","volume":"69","year":"2020","journal-title":"Gut"},{"key":"hep31836-bib-0003-20250824","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1038\/s41575-018-0045-2","article-title":"Novel perspectives in the management of decompensated cirrhosis","volume":"15","year":"2018","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"hep31836-bib-0004-20250824","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/S0168-8278(00)00009-X","article-title":"Dynamics of albumin in plasma and ascitic fluid in patients with cirrhosis","volume":"34","year":"2001","journal-title":"J Hepatol"},{"key":"hep31836-bib-0005-20250824","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1002\/hep.22913","article-title":"Alterations in the functional capacity of albumin in patients with decompensated cirrhosis is associated with increased mortality","volume":"50","year":"2009","journal-title":"Hepatology"},{"key":"hep31836-bib-0006-20250824","first-page":"781","article-title":"Increased vascular permeability: a major cause of hypoalbuminaemia in disease and injury","volume":"1","year":"1985","journal-title":"Lancet"},{"key":"hep31836-bib-0007-20250824","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1038\/sj.bjp.0707251","article-title":"Physiological and pathological changes in the redox state of human serum albumin critically influence its binding properties","volume":"151","year":"2007","journal-title":"Br J Pharmacol"},{"key":"hep31836-bib-0008-20250824","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1097\/01.SLA.0000055547.93484.87","article-title":"Hypoalbuminemia in acute illness: is there a rationale for intervention? 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