ALBUMIN
Management of liver disease
Several studies have clearly established that albumin is effective in preventing or treating specific complications of cirrhosis . Recent studies suggest that long-term albumin administration to patients with decompensated cirrhosis may act as a disease-modifying agent , easing the control of ascites , preventing the development of major complications and improving patient survival
Giacomo Zaccherini MD Manuel Tufoni MD Mauro Bernardi MD Department of Medical and Surgical Sciences , University of Bologna , Italy
Hypoalbuminaemia is a typical feature of cirrhosis and represents an important and adverse prognostic factor . It results from both a decreased synthesis by liver cells and , to a lesser extent , to other factors such as plasma volume expansion diluting the extracellular fluid protein content , due to the renal retention of sodium and water , and an increased trans-capillary escape rate of albumin , which leads to the protein being lost in the extravascular space .
Several studies have clearly established that albumin is effective in counteracting the haemodynamic dysfunction of advanced cirrhosis , which results from an arterial vasodilation located mainly in the splanchnic area and represents a common background for the development of several complications . These favourable effects are likely due not only to volume expansion but also to the non-oncotic properties of albumin , such as its antioxidant and scavenger activities , and its ability to modulate immune responses and preserve capillary integrity and permeability . 1 These non-oncotic properties assume further relevance in the light of several investigations which show that patients with advanced cirrhosis serum albumin undergo several molecular alterations that endanger these functions . 2 – 5 Moreover , the pathophysiological background of decompensated cirrhosis is characterised by a sustained pro-inflammatory and pro-oxidant state responsible for cardiovascular and multiorgan dysfunction . 6
Indications for albumin administration in cirrhosis Prevention of renal failure in spontaneous bacterial peritonitis Spontaneous bacterial peritonitis ( SBP ) is a frequent and life-threatening infection of ascitic fluid . The diagnosis is based on the presence of > 250 polymorphonuclear cells / mm 3 in ascites , in the absence of an intra-abdominal source of infection or malignancy . 7 Even without the occurrence of
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