Effects of Albumin Treatment on Systemic and Portal Hemodynamics and Systemic Inflammation in Patients With Decompensated Cirrhosis

Abstract

This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e17 (https://www. gastrojournal.org/cme/home). Learning Objective: Upon completion of this CME activity, successful learners will be able to (1) discuss the clinical relevance of normalizing serum albumin concentration in patients with decompensated cirrhosis and ascites and (2) identify the main mechanisms of action of albumin in this setting. Effects of long-term albumin treatment on serum albumin levels and inflammatory cytokines High albumin dose (HAlbD: 1.5 g/kg every week, blue figures) but not low albumin dose (LAlbD: 1 g/kg every 2 weeks: red figures) normalized serum albumin levels and decreased inflammatory cytokines

News in pathophysiology, definition and classification of hepatorenal syndrome: A step beyond the International Club of Ascites (ICA) consensus document

“…Accordingly, terlipressin was introduced to counteract splanchnic arterial vasodilation 17 while albumin was introduced to further improve effective circulating volume and to improve cardiac contractility. 17,[76][77][78] However, according to recent developments in the pathophysiology of HRS, two main questions arise. Firstly, to what extent does the presence of systemic inflammation and oxidative stress affect the rate of response to vasoconstrictors plus albumin?…”

“…87 To date, albumin has been given at a dose of 20-40 g/day and managed only according to the level of central venous pressure in order to avoid circulatory overload. Now, there is increasing experimental 77 and clinical 76,78 evidence that the increase in systemic vascular resistance and CO due to albumin are mainly related to the non-oncotic properties of the molecule and particularly to its capacity to exert anti-oxidant and anti-inflammatory actions. The role and details of these actions go beyond the scope of this manuscript, nevertheless, it is important to highlight two concepts.…”

“…ment of the cardio circulatory function as well as an anti-inflammatory effect is quite high (1.5 g/kg of bodyweight/week). 78 Up to now, this dose has never been usedin patients with HRS-AKI, thus its efficacy and safety should be proved in RCTs. The second is that while exerting its non-oncotic actions, the molecule of albumin goes through post-transitional changes that consume its biological potential.…”

Precipitants of Acute‐on‐Chronic Liver Failure: An Opportunity for Preventative Measures to Improve Outcomes

“…In fact, although infection‐precipitated ACLF is associated with a worse prognosis (51% infection‐precipitated versus 38% noninfection‐precipitated 90‐day transplant‐free mortality), if appropriate antibiotics were given, then on multivariate analysis only the appropriate use of antibiotics was significantly associated with 90‐day transplant‐free survival (hazard ratio, 0.40; 95% confidence interval, 0.26‐0.62; P < 0.001) . Furthermore, there appear to be 2 alternatives to mitigate the impact of infection on mortality in ACLF: The use of albumin to limit the burst of systemic inflammation associated with ACLF The administration of prophylactic antibiotics in patients with a high risk of infection …”

The impact of albumin infusion on the risk of rebleeding and in-hospital mortality in cirrhotic patients admitted for acute gastrointestinal bleeding: a retrospective study of a single institute

“…Also, the dose-dependent effect of albumin in reducing rebleeding does not support the view that a higher dose leads to more bleeding events. In fact, a recent study suggests that the portal pressure was not affected after the infusion of albumin (1.5g/kg, every week) [6]. Hence, the concern that albumin infusion increases the risk of rebleeding due to deterioration of portal pressure seems unnecessary.…”