Effects of Albumin Treatment on Systemic and Portal Hemodynamics and Systemic Inflammation in Patients With Decompensated Cirrhosis
Fernández, Javier (Hospital Clínic i Provincial de Barcelona)
Clària, J (Hospital Clínic i Provincial de Barcelona)
Amorós, Alex (Grifols)
Aguilar, Ferran (Grifols)
Castro, Miriam (Hospital Clínic i Provincial de Barcelona)
Casulleras, Mireia (Hospital Clínic i Provincial de Barcelona)
Acevedo, Juan (Derriford Hospital)
Duran, Marta (Hospital Clínic i Provincial de Barcelona)
Nuñez, Laura (Grifols)
Costa, Montserrat (Grifols)
Torres, Mireia (Grifols)
Horrillo, Raquel (Grifols)
Ruiz-del-Árbol, Luis (Hospital Universitario Ramón y Cajal (Madrid))
Villanueva, Càndid (Institut d'Investigació Biomèdica Sant Pau)
Prado, Veronica (Hospital Clínic i Provincial de Barcelona)
Arteaga, Mireya (Hospital Clínic i Provincial de Barcelona)
Trebicka, Jonel (University Hospital of Bonn)
Angeli, Paolo (University of Padova)
Merli, Manuela (Sapienza University of Rome)
Alessandria, Carlo (San Giovanni Battista Hospital)
Aagaard, Niels Kristian (Aarhus University Hospital (Aarhus, Dinamarca))
Soriano, German (Institut d'Investigació Biomèdica Sant Pau)
Durand, Francois (Hopital Beaujon)
Gerbes, Alexander L. (LMU Munich)
Gustot, Thierry (Erasme Hospital (ULB))
Welzel, Tania M. (Goethe University)
Salerno, Francesco (Policlinico IRCCS San Donato)
Bañares, Rafael (Hospital General Universitario Gregorio Marañón)
Vargas Blasco, Víctor (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Albillos, Agustín (Hospital Universitario Ramón y Cajal (Madrid))
Silva, Anibal (Hospital Clínic i Provincial de Barcelona)
Morales Ruiz, Manuel (Hospital Clínic i Provincial de Barcelona)
García-Pagán, JC. (Hospital Clínic i Provincial de Barcelona)
Pavesi, Marco (Grifols)
Jalan, Rajiv (Royal Free Hospital)
Bernardi, Mauro (University of Bologna)
Moreau, Richard (Université Paris Diderot-Paris 7)
Páez, Antonio (Grifols)
Arroyo, Vicente (Grifols)
Universitat Autònoma de Barcelona

Date:	2019
Abstract:	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.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Immune Response ; Interventional Trials ; Liver-Related Complications ; Splanchnic Hemodynamics
Published in:	Gastroenterology, Vol. 157 Núm. 1 (july 2019) , p. 149-162, ISSN 1528-0012

DOI: 10.1053/j.gastro.2019.03.021
PMID: 30905652

14 p, 1.5 MB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles