TY  - JOUR
A1  - Fernández, Javier
A1  - Clària, Joan
A1  - Amorós, Alex
A1  - Aguilar, Ferrán
A1  - Castro, Miriam
A1  - Casulleras, Mireia
A1  - Acevedo, Juan
A1  - Duran-Güell, Marta
A1  - Nuñez, Laura
A1  - Costa, Montserrat
A1  - Torres, Mireia
A1  - Horrillo, Raquel
A1  - Ruiz-del-Árbol, Luis
A1  - Villanueva, Cándido
A1  - Prado, Verónica
A1  - Arteaga, Mireya
A1  - Trebicka, Jonel
A1  - Angeli, Paolo
A1  - Merli, Manuela
A1  - Alessandria, Carlo
A1  - Aagaard, Niels Kristian
A1  - Soriano, German
A1  - Durand, François
A1  - Gerbes, Alexander L.
A1  - Gustot, Thierry
A1  - Welzel, Tania Mara
A1  - Salerno, Francesco
A1  - Bañares, Rafael
A1  - Vargas Blasco, Victor Manuel
A1  - Albillos, Agustin
A1  - Silva, Aníbal
A1  - Morales-Ruiz, Manuel
A1  - García-Pagán, Juan Carlos
A1  - Pavesi, Marco
A1  - Jalan, Rajiv
A1  - Bernardi, Mauro
A1  - Moreau, Richard
A1  - Páez, Antonio
A1  - Arroyo, Vicente
T1  - Effects of albumin treatment on systemic and portal hemodynamics and systemic inflammation in patients with decompensated cirrhosis
T2  - Gastroenterology
N2  - 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. ClinicalTrials.gov, Numbers: NCT00968695 and NCT03451292.
KW  - Liver-Related Complications
KW  - Immune Response
KW  - Splanchnic Hemodynamics
KW  - Interventional Trials
Y1  - 2019
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/50353
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-503533
SN  - 1528-0012
SN  - 0016-5085
N1  - © 2019 by the AGA Institute. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
VL  - 157
SP  - 149
EP  - 162
PB  - HighWire Press ; Saunders
CY  - Stanford, Calif. ; Philadelphia, Pa. [u. a.]
ER  -