Open Access

Javier Fernández, Joan Clària, Alex Amorós, Ferrán Aguilar, Miriam Castro, Mireia Casulleras, Juan Acevedo, Marta Duran-Güell, Laura Nuñez, Montserrat Costa, Mireia Torres, Raquel Horrillo, Luis Ruiz-del-Árbol, Cándido Villanueva, Verónica Prado, Mireya Arteaga, Jonel Trebicka, Paolo Angeli, Manuela Merli, Carlo Alessandria, Niels Kristian Aagaard, German Soriano, François Durand, Alexander L. Gerbes, Thierry Gustot, Tania Mara Welzel, Francesco Salerno, Rafael Bañares, Victor Manuel Vargas Blasco, Agustin Albillos, Aníbal Silva, Manuel Morales-Ruiz, Juan Carlos García-Pagán, Marco Pavesi, Rajiv Jalan, Mauro Bernardi, Richard Moreau, Antonio Páez, Vicente Arroyo

• 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.