Hepatic Encephalopathy and Albumin Lasting Cognitive Improvement

Inclusion Criteria: * Age \>18 years * Cirrhosis diagnosed using either (a) liver biopsy, (b) transient wave elastography (\>20 KPa) (c) radiological evidence consistent with cirrhosis, (d) in a patient with chronic liver disease endoscopic or radiological evidence of varices (e), in a patient with chronic liver disease, platelet count \<150,000/mm3 and AST/ALT ratio \>1. * Cognitive impairment defined by MHE on psychometric hepatic encephalopathy score (PHES), critical flicker frequency (CFF), or EncephalApp Stroop * Prior HE controlled by lactulose or rifaximin for at least one month * Serum albumin \<4gm/dl Exclusion Criteria: * Unclear diagnosis of cirrhosis * No prior overt HE * No cognitive impairment on the tests noted * Requiring regular albumin infusions within 3 months or anticipated during the study visit * Infection within a month * Allergies to albumin * Unlikely to be adherent to the study * Unable or unwilling to consent * West Haven Criteria\>2 * Alcohol abuse within 1 month * Serum albumin \>4gm/dl * Congestive heart failure