The use of albumin in the complications of cirrhosis: evidence and future perspectives

Alessandra Tovoli, Giacomo Zaccherini, Lucia Napoli, Carmen Serena Ricci, Manuel Tufoni, Paolo Caraceni

DOI: https://doi.org/10.7175/rhc.v4i3.659

Abstract

The therapeutic use of albumin in cirrhosis dates back to the 50s, when hypoalbuminemia was thought to play a crucial role in the pathophysiology of ascites. Today, while its efficacy in the treatment of ascites is still under investigation, it has been proved that albumin is able to improve patient outcome and survival in some specific complications of cirrhosis, such as the prevention of post-paracentesis circulatory dysfunction and the treatment of spontaneous bacterial peritonitis and hepatorenal syndrome. Beside its oncotic power, albumin carries other biological properties, the so called non-oncotic properties, including transportation and detoxification of several molecules, free radical scavenging, modulation of vascular permeability, activity on the immune system and on the haemostatic balance. Some experimental evidences indicate that not only albumin concentration but also its function is reduced in patients with cirrhosis. However, the clinical implications of such functional abnormalities is still unclear. We here present the available evidence on the use of albumin in cirrhosis and future perspectives.

Keywords

Albumin; Liver cirrhosis; Ascites

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References

  • Kragh-Hansen U. Structure and ligand binding properties of human serum albumin. Dan Med Bull 1990; 37: 57-84
  • Li L, Hitchcock AP, Cornelius R, et al. X-ray microscopy studies of protein adsorption on a phase segregated polystyrene/polymethylmethacrylate surface. 2. Effect of pH on site preference. J Phys Chem B 2008; 112: 2150-8; http://dx.doi.org/10.1021/jp076583h
  • Quinlan GJ, Martin GS, Evans TW. Albumin: biochemical properties and therapeutic potential. Hepatology 2005; 41: 1211-9; http://dx.doi.org/10.1002/hep.20720
  • Chen W, Gassner B, Börner S, et al. Atrial natriuretic peptide enhances microvascular albumin permeability by the caveolae-mediated transcellular pathway. Cardiovasc Res 2012; 93: 141-51; http://dx.doi.org/10.1093/cvr/cvr279
  • Doweiko JP, Nompleggi DJ. Role of albumin in human physiology and pathophysiology. JPEN J Parenter Enteral Nutr 1991; 15: 207-11; http://dx.doi.org/10.1177/0148607191015002207
  • Mirici-Cappa F, Caraceni P, Domenicali M, et al. How albumin administration for cirrhosis impacts on hospital albumin consumption and expenditure. World J Gastroenterol 2011; 17: 3479-86; http://dx.doi.org/10.3748/wjg.v17.i30.3479
  • Bernardi M, Maggioli C, Zaccherini G. Human albumin in the management of complications of liver cirrhosis. Crit Care 2012; 16: 211; http://dx.doi.org/10.1186/cc11218
  • Fanali G, Di Masi A, Trezza V, et al. Human serum albumin: from bench to bedside. Mol Aspects Med 2012; 33: 209-90; http://dx.doi.org/10.1016/j.mam.2011.12.002
  • Henriksen JH, Siemssen O, Krintel JJ, et al. Dynamics of albumin in plasma and ascitic fluid in patients with cirrhosis. J Hepatol 2001; 34: 53-60; http://dx.doi.org/10.1016/S0168-8278(00)00009-X
  • Wood L, Colman J, Dudley F. The relationship between portal pressure and plasma albumin in the development of cirrhotic ascites. J Gastroenterol Hepatol 1987; 2: 525-31; http://dx.doi.org/10.1111/j.1440-1746.1987.tb00200.x
  • Rector WG, Ibarra F, Openshaw K, et al. Ascites kinetics in cirrhosis: relationship to plasma-ascites hydrostatic-oncotic balance and intensity of renal sodium retention. J Lab Clin Med 1986; 107: 412-9;
  • Sanyal AJ, Bosch J, Blei A, et al. Portal hypertension and its complications. Gastroenterology 2008; 134: 1715-28; http://dx.doi.org/10.1053/j.gastro.2008.03.007
  • Arroyo V. Pathophysiology, diagnosis and treatment of ascites in cirrhosis. Ann Hepatol 2002; 1: 72-9
  • Bernardi M, Fornalè L, Di Marco C, et al. Hyperdynamic circulation of advanced cirrhosis: a re-appraisal based on posture-induced changes in hemodynamics. J Hepatol 1995; 22: 309-18; http://dx.doi.org/10.1016/0168-8278(95)80284-3
  • Møller S, Henriksen JH. Cardiovascular complications of cirrhosis. Postgrad Med J 2009; 85: 44-54
  • Wong F. Management of ascites in cirrhosis. J Gastroenterol Hepatol 2012; 27: 11-20; http://dx.doi.org/10.1111/j.1440-1746.2011.06925.x
  • Arroyo V. Review article: albumin in the treatment of liver diseases--new features of a classical treatment. Aliment Pharmacol Ther 2002; 16 Suppl 5: 1-5; http://dx.doi.org/10.1046/j.1365-2036.16.s5.1.x
  • European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol 2010; 53: 397-417; http://dx.doi.org/10.1016/j.jhep.2010.05.004
  • Runyon BA. Management of adult patients with ascites due to cirrhosis: an update. Hepatology 2009; 49: 2087-107; http://dx.doi.org/10.1002/hep.22853
  • Rimola A, García-Tsao G, Navasa M, et al. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club. J Hepatol 2000; 32: 142-53; http://dx.doi.org/10.1016/S0168-8278(00)80201-9
  • Guevara M, Arroyo V, Ginès P; Reply to: “Effect of albumin on survival in septic cirrhotic patients other than spontaneous bacterial peritonitis. The question remains open”. J Hepatol 2013; 58: 640; http://dx.doi.org/10.1016/j.jhep.2012.11.047
  • Follo A, Llovet JM, Navasa M, et al. Renal impairment after spontaneous bacterial peritonitis in cirrhosis: incidence, clinical course, predictive factors and prognosis. Hepatology 1994; 20: 1495-501; http://dx.doi.org/10.1002/hep.1840200619
  • Fasolato S, Angeli P, Dallagnese L, et al. Renal failure and bacterial infections in patients with cirrhosis: epidemiology and clinical features. Hepatology 2007; 45: 223-9; http://dx.doi.org/10.1002/hep.21443
  • Sort P, Navasa M, Arroyo V, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med 1999; 341: 403-9; http://dx.doi.org/10.1056/NEJM199908053410603
  • Sigal SH, Stanca CM, Fernandez J, et al. Restricted use of albumin for spontaneous bacterial peritonitis. Gut 2007; 56: 597-9; http://dx.doi.org/10.1136/gut.2006.113050
  • Fernández J, Gustot T. Management of bacterial infections in cirrhosis. J Hepatol 2012; 56 Suppl 1: S1-12; http://dx.doi.org/10.1016/S0168-8278(12)60002-6
  • Terg R, Gadano A, Cartier M, et al. Serum creatinine and bilirubin predict renal failure and mortality in patients with spontaneous bacterial peritonitis: a retrospective study. Liver Int 2009; 29: 415-9; http://dx.doi.org/10.1111/j.1478-3231.2008.01877.x
  • Poca M, Concepción M, Casas M, et al. Role of albumin treatment in patients with spontaneous bacterial peritonitis. Clin Gastroenterol Hepatol 2012; 10: 309-15; http://dx.doi.org/10.1016/j.cgh.2011.11.012
  • De Araujo A, De Barros Lopes A, Rossi G, et al. Low-dose albumin in the treatment of spontaneous bacterial peritonitis: should we change the standard treatment? Gut 2012; 61: 1371-2; http://dx.doi.org/10.1136/gutjnl-2011-301739
  • Fernández J, Monteagudo J, Bargallo X, et al. A randomized unblinded pilot study comparing albumin versus hydroxyethyl starch in spontaneous bacterial peritonitis. Hepatology 2005; 42: 627-34; http://dx.doi.org/10.1002/hep.20829
  • Salerno F, Navickis RJ, Wilkes MM. Albumin infusion improves outcomes of patients with spontaneous bacterial peritonitis: a meta-analysis of randomized trials. Clin Gastroenterol Hepatol 2013; 11: 123-30.e1; http://dx.doi.org/10.1016/j.cgh.2012.11.007
  • Salerno F, Gerbes A, Ginès P, et al. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Gut 2007; 56: 131-8
  • Ginès P, Schrier RW. Renal failure in cirrhosis. N Engl J Med 2009; 361: 1279-90; http://dx.doi.org/10.1056/NEJMra0809139
  • Bortoluzzi A, Ceolotto G, Gola E, et al. Positive cardiac inotropic effect of albumin infusion in rodents with cirrhosis and ascites: molecular mechanisms. Hepatology 2013; 57: 266-76; http://dx.doi.org/10.1002/hep.26021
  • Martín-Llahí M, Pépin M-N, Guevara M, et al. Terlipressin and albumin vs albumin in patients with cirrhosis and hepatorenal syndrome: a randomized study. Gastroenterology 2008; 134: 1352-9; http://dx.doi.org/10.1053/j.gastro.2008.02.024
  • Ortega R, Ginès P, Uriz J, et al. Terlipressin therapy with and without albumin for patients with hepatorenal syndrome: results of a prospective, nonrandomized study. Hepatology 2002; 36: 941-8; http://dx.doi.org/10.1053/jhep.2002.35819
  • Neri S, Pulvirenti D, Malaguarnera M, et al. Terlipressin and albumin in patients with cirrhosis and type I hepatorenal syndrome. Dig Dis Sci 2008; 53: 830-5; http://dx.doi.org/10.1007/s10620-007-9919-9
  • Sanyal AJ, Boyer T, Garcia-Tsao G, et al. A randomized, prospective, double-blind, placebo-controlled trial of terlipressin for type 1 hepatorenal syndrome. Gastroenterology 2008; 134: 1360-8; http://dx.doi.org/10.1053/j.gastro.2008.02.014
  • Gluud LL, Christensen K, Christensen E, et al. Systematic review of randomized trials on vasoconstrictor drugs for hepatorenal syndrome. Hepatology 2010; 51: 576-84; http://dx.doi.org/10.1002/hep.23286
  • Ruiz-del-Arbol L, Monescillo A, Jimenéz W, et al. Paracentesis-induced circulatory dysfunction: mechanism and effect on hepatic hemodynamics in cirrhosis. Gastroenterology 1997; 113: 579-86; http://dx.doi.org/10.1053/gast.1997.v113.pm9247479
  • Ginès A, Fernández-Esparrach G, Monescillo A, et al. Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis. Gastroenterology 1996; 111: 1002-10; http://dx.doi.org/10.1016/S0016-5085(96)70068-9
  • Ginès P, Titó L, Arroyo V, et al. Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis. Gastroenterology 1988; 94: 1493-502
  • Sola-Vera J, Mi-ana J, Ricart E, et al. Randomized trial comparing albumin and saline in the prevention of paracentesis-induced circulatory dysfunction in cirrhotic patients with ascites. Hepatology 2003; 37: 1147-53; http://dx.doi.org/10.1053/jhep.2003.50169
  • Moreau R, Valla D-C, Durand-Zaleski I, et al. Comparison of outcome in patients with cirrhosis and ascites following treatment with albumin or a synthetic colloid: a randomised controlled pilot trail. Liver Int 2006; 26: 46-54; http://dx.doi.org/10.1111/j.1478-3231.2005.01188.x
  • Singh V, Kumar R, Nain CK, et al. Terlipressin versus albumin in paracentesis-induced circulatory dysfunction in cirrhosis: a randomized study. J Gastroenterol Hepatol 2006; 21: 303-7; http://dx.doi.org/10.1111/j.1440-1746.2006.04182.x
  • Moreau R, Asselah T, Condat B, et al. Comparison of the effect of terlipressin and albumin on arterial blood volume in patients with cirrhosis and tense ascites treated by paracentesis: a randomised pilot study. Gut 2002; 50: 90-4; http://dx.doi.org/10.1136/gut.50.1.90
  • Appenrodt B, Wolf A, Grünhage F, et al. Prevention of paracentesis-induced circulatory dysfunction: midodrine vs albumin. A randomized pilot study. Liv Int 2008; 28: 1019-25; http://dx.doi.org/10.1111/j.1478-3231.2008.01734.x
  • Bari K, Mi-ano C, Shea M, et al. The combination of octreotide and midodrine is not superior to albumin in preventing recurrence of ascites after large-volume paracentesis. Clin Gastroenterol Hepatol 2012; 10: 1169-75; http://dx.doi.org/10.1016/j.cgh.2012.06.027
  • Bernardi M, Caraceni P, Navickis RJ, et al. Albumin infusion in patients undergoing large-volume paracentesis: a meta-analysis of randomized trials. Hepatology 2012; 55: 1172-81; http://dx.doi.org/10.1002/hep.24786
  • Alessandria C, Elia C, Mezzabotta L, et al. Prevention of paracentesis-induced circulatory dysfunction in cirrhosis: standard vs half albumin doses. A prospective, randomized, unblinded pilot study. Dig Liver Dis 2011; 43: 881-6
  • Clermont R, Vlahevic Z, Chalmers T, et al. Intravenous therapy of massive ascites in patients with cirrhosis. II. Long-term effects on survival and frequency of renal failure. Gastroenterology 1967; 53: 220-8
  • Wilkinson P, Sherlock S. The effect of repeated albumin infusions in patients with cirrhosis. Lancet 1962; 2: 1125-9; http://dx.doi.org/10.1016/S0140-6736(62)90895-4
  • Gentilini P, Casini-Raggi V, Di Fiore G, et al. Albumin improves the response to diuretics in patients with cirrhosis and ascites: results of a randomized, controlled trial. J Hepatol 1999; 30: 639-45; http://dx.doi.org/10.1016/S0168-8278(99)80194-9
  • Romanelli R-G, La Villa G, Barletta G, et al. Long-term albumin infusion improves survival in patients with cirrhosis and ascites: an unblinded randomized trial. World J Gastroenterol 2006; 12: 1403-7
  • Human Albumin for the Treatment of Ascites in Patients With Hepatic Cirrhosis (ANSWER). Clinicaltrials.gov NCT 01288794
  • Terra C, Guevara M, Torre A, et al. Renal failure in patients with cirrhosis and sepsis unrelated to spontaneous bacterial peritonitis: value of MELD score. Gastroenterology 2005; 129: 1944-53; http://dx.doi.org/10.1053/j.gastro.2005.09.024
  • Fasolato S, Angeli P, Dallagnese L, et al. Renal failure and bacterial infections in patients with cirrhosis: epidemiology and clinical features. Hepatology 2007; 45: 223-9; http://dx.doi.org/10.1002/hep.21443
  • Pereira G, Guevara M, Fagundes C, et al. Renal failure and hyponatremia in patients with cirrhosis and skin and soft tissue infection. A retrospective study. J Hepatol 2012; 56: 1040-6; http://dx.doi.org/10.1016/j.jhep.2011.11.023

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