RT Journal Article
SR Electronic
T1 Albumin in decompensated cirrhosis: new concepts and perspectives
JF Gut
JO Gut
FD BMJ Publishing Group Ltd and British Society of Gastroenterology
SP 1127
OP 1138
DO 10.1136/gutjnl-2019-318843
VO 69
IS 6
A1 Mauro Bernardi
A1 Paolo Angeli
A1 Joan Claria
A1 Richard Moreau
A1 Pere Gines
A1 Rajiv Jalan
A1 Paolo Caraceni
A1 Javier Fernandez
A1 Alexander L Gerbes
A1 Alastair J O'Brien
A1 Jonel Trebicka
A1 Thierry Thevenot
A1 Vicente Arroyo
YR 2020
UL http://gut.bmj.com/content/69/6/1127.abstract
AB The pathophysiological background of decompensated cirrhosis is characterised by a systemic proinflammatory and pro-oxidant milieu that plays a major role in the development of multiorgan dysfunction. Such abnormality is mainly due to the systemic spread of bacteria and/or bacterial products from the gut and danger-associated molecular patterns from the diseased liver triggering the release of proinflammatory mediators by activating immune cells. The exacerbation of these processes underlies the development of acute-on-chronic liver failure. A further mechanism promoting multiorgan dysfunction and failure likely consists with a mitochondrial oxidative phosphorylation dysfunction responsible for systemic cellular energy crisis. The systemic proinflammatory and pro-oxidant state of patients with decompensated cirrhosis is also responsible for structural and functional changes in the albumin molecule, which spoil its pleiotropic non-oncotic properties such as antioxidant, scavenging, immune-modulating and endothelium protective functions. The knowledge of these abnormalities provides novel targets for mechanistic treatments. In this respect, the oncotic and non-oncotic properties of albumin make it a potential multitarget agent. This would expand the well-established indications to the use of albumin in decompensated cirrhosis, which mainly aim at improving effective volaemia or preventing its deterioration. Evidence has been recently provided that long-term albumin administration to patients with cirrhosis and ascites improves survival, prevents complications, eases the management of ascites and reduces hospitalisations. However, variant results indicate that further investigations are needed, aiming at confirming the beneficial effects of albumin, clarifying its optimal dosage and administration schedule and identify patients who would benefit most from long-term albumin administration.