Point-of-care ultrasound of the inferior vena cava for intravascular volume assessment during intravenous albumin infusion in patients with cirrhosis
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background & Aims Current guidelines recommend intravenous (IV) albumin for different indications in decompensated cirrhosis, but iatrogenic hypervolemia following IV albumin is increasingly reported. We aimed to characterize intravascular volume status using point-of-care ultrasound (POCUS) of the inferior vena cava (IVC) during passive leg raise (PLR) and IV albumin, potentially facilitating clinical management and adjusting albumin dosage. Methods This prospective pilot cohort included patients with decompensated cirrhosis requiring IV albumin. We assessed changes in minimal and maximal IVC diameters (IVC min , IVC max ) and collapsibility (IVCCI) during PLR and after IV albumin. We defined severe intravascular volume overload as IVC max >2.1 cm and IVCCI<20%. Clinical outcomes were recorded until 3 months after POCUS. Results We included 81 measurements in 55 individual patients (70.9% male, median age 62 years, 58.2% alcohol related cirrhosis, median Child-Pugh score 9 points, 89.1% paracentesis, median 40 g IV albumin, 5.5 l ascites) . We found a significant increase in IVC diameters both during PLR (change in mean [Δ] IVC min +20.7%, Δ IVC max +14.1%,p<0.01) and after IV albumin (Δ IVC min +58.8%, Δ IVC max +48.2%,p<0.01). There was a significant decrease in IVCCI during PLR (relative Δ-11.1%,p<0.01) and after IV albumin (relative Δ -18.0%,p<0.01). Potential severe intravascular volume overload occurred on 17 occasions (21%) after IV albumin, more frequently in women than men (40 vs 15.7%, p<0.01), and showed higher cumulative incidence rates in variceal bleeding after 1 (16.7% vs. 0%, p=0.01) and 3 months (18.2% vs 0%, p=0.01). Conclusions Potential severe intravascular volume overload after IV albumin was detected in every fifth patient with decompensated cirrhosis. Impact and Implications Iatrogenic volume overload after albumin infusions in patients with cirrhosis is a potentially harmful side effect, and no policy for monitoring intravascular volume overload using noninvasive tools has been suggested so far. New-onset potential volume overload was detected in almost 1/5 of men and 4/10 of women and was associated with increases in N-terminal prohormone of brain natriuretic peptide, lower mean arterial pressure during albumin infusion, and higher serum sodium levels. Our results from this proof-of-concept study emphasize the need for larger prospective cohort studies to validate our findings and introduce strategies for individualizing volume management in patients with decompensated cirrhosis.
Source: JHEP Reports
Institutions: University of Bern, University Hospital of Bern
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,110
Funder: AstraZeneca
OpenAlex ID: W4413353188