Personalised Long-Term Albumin Treatment Based on Three-Month Ascites Response in Patients With Decompensated Cirrhosis

Background and Aims: Long-term albumin (LTA) is effective for treating ascites in decompensated cirrhosis. This study aims to analyse the clinical courses of patients receiving LTA and provide a 3 month stratification to personalise management integrating LTA with other options. Methods: Patients receiving LTA included in the multicentre, retrospective, observational Real-ANSWER study were stratified into three categories according to the response of ascites after 3 months of treatment: ‘responders’ (grade 0–1 ascites), ‘partial responders’ (at least grade 2 ascites not receiving therapeutic paracentesis) and ‘non-responders’ (at least grade 2 ascites receiving therapeutic paracentesis). Clinical trajectories and outcomes of the different categories were compared. Results: Of the 252 patients included (median Child-Pugh 9, MELDNa 18), 36% were responders, 29% partial responders and 35% non-responders. Responders differed significantly from the other groups, with higher cumulative incidence of LTA discontinuation for clinical improvement (33%) and transplantation (26%), a lower 18 month mortality (13%) and minimal use of TIPS. Partial and non-responders showed similar trajectories with high mortality (35% and 42%) and low incidence of transplantation (12% and 11%). TIPS was performed predominantly among non-responders (15%). Both groups had a few patients (12% and 8%) able to stop LTA for clinical improvement frequently related to an effective etiologic treatment. Conclusions: Using a 3 month stratification according to the ascites response of LTA, patients can be grouped into three categories with different clinical courses and outcomes. This may help to stratify prognosis and inform clinical discussions on the management of ascites by integrating LTA with other available options.