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Effects of Albumin Treatment on Systemic and Portal Hemodynamics and Systemic Inflammation in Patients With Decompensated Cirrhosis. 2019
Javier Fernández, and
Joan Clària, and
Alex Amorós, and
Ferrán Aguilar, and
Miriam Castro, and
Mireia Casulleras, and
Juan Acevedo, and
Marta Duran-Güell, and
Laura Nuñez, and
Montserrat Costa, and
Mireia Torres, and
Raquel Horrillo, and
Luis Ruiz-Del-Árbol, and
Cándido Villanueva, and
Verónica Prado, and
Mireya Arteaga, and
Jonel Trebicka, and
Paolo Angeli, and
Manuela Merli, and
Carlo Alessandria, and
Niels Kristian Aagaard, and
German Soriano, and
François Durand, and
Alexander Gerbes, and
Thierry Gustot, and
Tania M Welzel, and
Francesco Salerno, and
Rafael Bañares, and
Victor Vargas, and
Agustin Albillos, and
Aníbal Silva, and
Manuel Morales-Ruiz, and
Juan Carlos García-Pagán, and
Marco Pavesi, and
Rajiv Jalan, and
Mauro Bernardi, and
Richard Moreau, and
Antonio Páez, and
Vicente Arroyo
EF Clif, EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain; Hospital Clínic, IDIBAPS and CIBERehd, Barcelona, Spain. Electronic address: javier.fernandez@efclif.com.
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. 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). 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. 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. ClinicalTrials.gov, Numbers: NCT00968695 and NCT03451292.
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