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High-dose albumin reduces systemic inflammation in cirrhosis

Treatment with high-dose levels of albumin reduced systemic inflammation and cardiocirculatory dysfunction in patients with decompensated cirrhosis, according to an analysis published in Gastroenterology.

“Recent investigations have suggested that systemic inflammation plays a major role in the pathogenesis of acute decompensation and [acute-on-chronic liver failure] in cirrhosis,” Javier Fernández, MD, PhD, from the Hospital Clinic of Barcelona in Spain, and colleagues wrote. “The current study allowed us to uncover important findings related to the efficacy of albumin treatment in cirrhosis. The most outstanding were that high doses of albumin, but not low doses of albumin, in patients with decompensated cirrhosis have significant immunomodulatory effects.”

Fernández and colleagues analyzed data from the Pilot-PRECIOSA study and INFECIR-2 study, comprising a total of 13 patients who had baseline hypoalbuminemia. During the study, patients either received a low dose of 1 g/kg albumin every 2 weeks (n = 7) or a high dose of 1.5 g/kg every week (n = 6).

All patients in the high dose group achieved on-treatment normalized serum albumin concentration (P <. 001) compared with one patient in the low dose group.

Similarly, patients in the high dose group were more likely to have frequent positive peaks of plasma renin activity (P = .04) that suggested albumin was capable of stabilizing circulatory function, and most patients in the high dose group had a reduction of plasma IL-6 of more than 20% (P = .003) compared with one patient in the low dose group.

Treatment with higher doses of albumin also correlated with a significant increase in cardiac index, systolic volume and left ventricular stroke work index, indicating an increase in left ventricular function.

“The most relevant finding of our study was the observation that both long-term and short-term albumin treatment, if given at high dosage, are associated with significant immunomodulatory effects in decompensated cirrhosis,” the researchers concluded. – by Talitha Bennett

Disclosure: Fernández reports research support from Grifols. Please see the full study for all other authors’ relevant financial disclosures.