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Title: Effects of Albumin Treatment on Systemic and Portal Hemodynamics and Systemic Inflammation in Patients With Decompensated Cirrhosis
Author: Fernández Gómez, Javier
Clària i Enrich, Joan
Amorós, Àlex
Aguilar, Ferran
Castro, Miriam
Casulleras, Mireia
Acevedo, Juan
Duran Güell, Marta
Nuñez, Laura
Costa, Montserrat
Torres Hurtado, Mirea
Horrillo, Raquel
Ruiz-del-Árbol, Luis
Villanueva Sánchez, Càndid
Prado, Verónica
Arteaga López, Mireya
Trebicka, Jonel
Angeli, Paolo
Merli, Manuela
Alessandria, Carlo
Aagaard, Niels Kristian
Soriano Pastor, Germán
Durand, François
Gerbes, Alexander L.
Gustot, Thierry
Welzel, Tania Mara
Salerno, Francesco
Bañares, Rafael
Vargas, Víctor
Albillos, Agustín
Silva, Aníbal
Morales Ruiz, Manuel
Pavesi, Marco
Jalan, Rajiv
Bernardi, Mauro
Moreau, Richard
Páez, Antonio
Arroyo, Vicente
Keywords: Inflamació
Cirrosi hepàtica
Assaigs clínics
Hepatic cirrhosis
Clinical trials
Issue Date: 1-Jan-2019
Publisher: Elsevier
Abstract: BACKGROUND & AIMS: We investigated the effect of albumin treatment (20% solution) on hypoalbuminemia, cardiocirculatory dysfunction, portal hypertension, and systemic inflammation in patients with decompensated cirrhosis with and without bacterial infections. METHODS: We performed a prospective study to assess the effects of long-term (12 weeks) treatment with low doses (1 g/kg body weight every 2 weeks) and high doses (1.5 g/kg every week) of albumin on serum albumin, plasma renin, cardiocirculatory function, portal pressure, and plasma levels of cytokines, collecting data from 18 patients without bacterial infections (the Pilot-PRECIOSA study). We also assessed the effect of short-term (1 week) treatment with antibiotics alone vs the combination of albumin plus antibiotics (1.5 g/kg on day 1 and 1 g/kg on day 3) on plasma levels of cytokines in biobanked samples from 78 patients with bacterial infections included in a randomized controlled trial (INFECIR-2 study). RESULTS: Circulatory dysfunction and systemic inflammation were extremely unstable in many patients included in the Pilot-PRECIOSA study; these patients had intense and reversible peaks in plasma levels of renin and interleukin 6. Long-term high-dose albumin, but not low-dose albumin, was associated with normalization of serum level of albumin, improved stability of the circulation and left ventricular function, and reduced plasma levels of cytokines (interleukin 6, granulocyte colony-stimulating factor, interleukin 1 receptor antagonist, and vascular endothelial growth factor) without significant changes in portal pressure. The immune-modulatory effects of albumin observed in the Pilot-PRECIOSA study were confirmed in the INFECIR-2 study. In this study, patients given albumin had significant reductions in plasma levels of cytokines. CONCLUSIONS: In an analysis of data from 2 trials (Pilot-PRECIOSA study and INFECIR-2 study), we found that albumin treatment reduced systemic inflammation and cardiocirculatory dysfunction in patients with decompensated cirrhosis. These effects might be responsible for the beneficial effects of albumin therapy on outcomes of patients with decompensated cirrhosis., Numbers: NCT00968695 and NCT03451292.
Note: Versió postprint del document publicat a:
It is part of: Gastroenterology, 2019, vol. 157, num. 1, p. 149-162
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ISSN: 0016-5085
Appears in Collections:Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)
Articles publicats en revistes (Biomedicina)

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