Figure taken from Choe et al Hepatology 2015.
Albumin could thus be repurposed as an effective immune restorative drug in patients with decompensated liver cirrhosis. We aim to evaluate treatment with 20% HAS to see if raising and maintaining serum albumin levels at near normal will result in fewer nosocomial infections in these patients and less sepsis-related organ failure, reduced length of stay and lower mortality.
Liver disease is a major challenge facing the NHS with bacterial infection the most serious cause of morbidity and mortality in patients with advanced liver disease.
A defective innate immune response was first observed in cirrhosis 30 years ago and is considered to underlie the predisposition to, and poor outcome from, infection. There is however no medical strategy to restore immune competence in these patients.
Elevated circulating Prostaglandin E2 (PGE2) levels have been shown to contribute to immune suppression in liver cirrhosis. PGE2 is more bioavailable and, consequently, more immune suppressive because of decreased serum albumin levels, as albumin binds and catalyses inactivation of PGE2. Albumin is synthesised exclusively in the liver and levels fall as the synthetic function of the liver declines with worsening cirrhosis. The functional binding capacity of albumin is also known to be dysfunctional in liver cirrhosis.
China L et al. Administration of Albumin Solution Increases Serum Levels of Albumin in Patients With Chronic Liver Failure in a Single-Arm Feasibility Trial. Clin Gastroenterol Hepatol. 2018 May;16(5):748-755.e6.
Choe, W. and S. Baik, Prostaglandin E2 -mediated immunosuppression and the role of albumin as its modulator. Hepatology, 2015. 61(3): p. 1080-2
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