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Randomized Trials of Interventions for Hospitalized Patients with Cirrhosis

To the Editor: In the ATTIRE trial, China et al. (March 4 issue)1 report the effect of daily albumin infusion on prevention of infections, kidney failure, and death in hospitalized patients with decompensated cirrhosis. The investigators found no apparent benefit to this strategy, and the patients in the albumin group had more serious life-threatening adverse events (particularly pulmonary edema and fluid overload) than those who received standard care (23 events vs. 8 events). The predominant cause of cirrhosis in the trial was alcohol abuse; many of the patients had alcoholic hepatitis. Cirrhotic cardiomyopathy usually becomes clinically evident as a result . . .