International Position Statement on Use of Human Albumin in Liver Cirrhosis-related Complications

Dear Friends and Investigators,

Thank you very much for your agreement to participate in the "International Position Statement on Use of Human Albumin Infusion for Liver Cirrhosis-related Complications (2022)".

As you know, an increasing amount of studies have recently evaluated the role of human albumin infusion for the management of various liver cirrhosis related complications. However, their conclusions remain controversial. On the other hand, its prescriptions are not evidence-based in real-world clinical practice. In this setting, I wish to organize a panel of investigators who are interested and skilled at the management of liver cirrhosis related complications to formulate an international practice guidance in this topic by comprehensively reviewing the available evidence. To follow the international rule on the production of a guideline or consensus, a three-round Delphi consensus process will be undertaken to complete the current practice guidance. At the first round of Delphi consensus process, two investigators initially reviewed relevant evidence and published guidelines/consensus, defined the main topics related to the position statement document, and elaborated the provisional statements. Then, a total of 15 investigators sufficiently discussed the significance of these topics and revised the original document in terms of position statements, background, context, evidence, and references as well as structure and writing.

Now, this is the second round of Delphi consensus process, which aims to assess the level of agreement with international position statements. You will be asked to respond from your personal perspectives and indicate the level of agreement or disagreement on a five-point Likert scale on position statements. Additionally, you can provide any comments at the end of each position statement in the online questionnaire. We will summarize and consider the comments from all investigators to improve each position statement.

Looking forward to your response at your earliest convenience.

Yours sincerely,

Dr. Xingshun Qi
On the behalf of Liver Cirrhosis-related Complications - International Special Interest Group
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Your name
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Title
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Country
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State or Province
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Affiliation
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Department
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Email
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Phone
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9.
Position statement 1. HA infusion should be used for the differential diagnosis of HRS.
Strongly agree (5 points)
Agree (4 points)
Neither agree nor disagree (3 points)
Disagree (2 points)
Strongly disagree (1 point)
Don't konw
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10.
Position statement 2. HA infusion should be used for the management of HRS.
Strongly agree (5 points)
Agree (4 points)
Neither agree nor disagree (3 points)
Disagree (2 points)
Strongly disagree (1 point)
Don't konw
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11.
Position statement 3. HA infusion should be used for the prevention of PPCD dysfunction in cirrhotic patients with liver cirrhosis and ascites undergoing large volume paracentesis (>5 L). HA infusion could be considered in cirrhotic patients with acute on chronic liver failure (ACLF)/AKI undergoing paracentesis of <5 L.
Strongly agree (5 points)
Agree (4 points)
Neither agree nor disagree (3 points)
Disagree (2 points)
Strongly disagree (1 point)
Don't konw
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12.
Position statement 4. Long-term regular HA infusion can be used to improve ascites, prevent other complications of liver cirrhosis, and prolong survival in patients with uncomplicated ascites requiring diuretics.
Strongly agree (5 points)
Agree (4 points)
Neither agree nor disagree (3 points)
Disagree (2 points)
Strongly disagree (1 point)
Don't know
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13.
Position statement 5. HA infusion should be used for the prevention of AKI and the improvement of survival in cirrhotic patients with SBP, particularly those with baseline serum bilirubin ≥4 mg/dL or serum creatinine ≥1 mg/dL.
Strongly agree (5 points)
Agree (4 points)
Neither agree nor disagree (3 points)
Disagree (2 points)
Strongly disagree (1 point)
Don't konw
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14.
Position statement 6. HA infusion does not prevent renal impairment or improve survival in patients with cirrhosis affected by non-SBP infections other than septic shock.
Strongly agree (5 points)
Agree (4 points)
Neither agree nor disagree (3 points)
Disagree (2 points)
Strongly disagree (1 point)
Don't konw
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15.
Position statement 7. HA infusion may be considered for the management of overt HE, especially in patients with liver cirrhosis and hypoalbuminemia.
Strongly agree (5 points)
Agree (4 points)
Neither agree nor disagree (3 points)
Disagree (2 points)
Strongly disagree (1 point)
Don't know
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16.
Position statement 8. HA infusion may be considered to improve and/or prevent hyponatremia in cirrhotic patients.
Strongly agree (5 points)
Agree (4 points)
Neither agree nor disagree (3 points)
Disagree (2 points)
Strongly disagree (1 point)
Don't konw
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17.
Position statement 9. More data are warranted to evaluate the use of HA to attenuate muscle cramps in patients with liver cirrhosis.
Strongly agree (5 points)
Agree (4 points)
Neither agree nor disagree (3 points)
Disagree (2 points)
Strongly disagree (1 point)
Don't know
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18.
Position statement 10. HA may be effective and safe for the management of cirrhotic patients with septic shock.
Strongly agree (5 points)
Agree (4 points)
Neither agree nor disagree (3 points)
Disagree (2 points)
Strongly disagree (1 point)
Don't know
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19.
Position statement 11. The survival benefit of short-term HA infusion in general patients with acute decompensation of cirrhosis should be further explored.
Strongly agree (5 points)
Agree (4 points)
Neither agree nor disagree (3 points)
Disagree (2 points)
Strongly disagree (1 point)
Don't know
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20.
Position statement 12. HA infusion is generally safe, but may induce the development of pulmonary edema and severe allergic reactions.
Strongly agree (5 points)
Agree (4 points)
Neither agree nor disagree (3 points)
Disagree (2 points)
Strongly disagree (1 point)
Don't know
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Other comments.
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