Hemodynamic and Systemic Effects of Albumin in Patients with Advanced Liver Disease
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MANAGEMENT OF THE CIRRHOTIC PATIENT (A CARDENAS AND P TANDON, SECTION EDITORS)
Hemodynamic and Systemic Effects of Albumin in Patients with Advanced Liver Disease Manuel Tufoni 1 & Maurizio Baldassarre 1,2 & Giacomo Zaccherini 1 & Agnese Antognoli 1,2 & Paolo Caraceni 1,2
# The Author(s) 2020
Abstract Purpose of Review Albumin administration is recommended to prevent or treat specific complications of decompensated cirrhosis based on its capacity to expand plasma volume. However, the molecule also has many other biological properties that are unrelated to the oncotic activity. The purpose of this review is to examine the hemodynamic and systemic effects of albumin administration in patients with decompensated cirrhosis. Recent Findings Besides plasma expansion, albumin appears to act against inflammation, facilitate immunocompetence, and improve cardiac and endothelial function, thus antagonizing critical steps in the pathophysiological cascade underlying decompensated cirrhosis. Summary Increasing knowledge of the pathophysiological mechanisms of the disease, as well the pleiotropic properties of the molecule, provides the rationale for considering albumin as a multi-target disease-modifying agent in decompensated cirrhosis. Both oncotic and non-oncotic properties likely concur with the clinical benefits of long-term albumin administration recently demonstrated in these patients. Keywords Liver cirrhosis . Albumin . Circulatory dysfunction . Systemic inflammation . Ascites
Introduction Human albumin is the most abundant protein circulating in the blood and has many biological functions. The administration of exogenous albumin started in World War II when it was used for fluid resuscitation in traumatic shock. Treatment with albumin has been extended to many other pathological conditions, despite the fact that its efficacy has either been disproved by evidence-based medicine or is still under debate.
Manuel Tufoni and Maurizio Baldassarre share co-first authorship. This article is part of the Topical Collection on Management of the Cirrhotic Patient * Paolo Caraceni [email protected] 1
Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, Via Albertoni 15, 40138 Bologna, Italy
2
Center for Applied Medical Research (CRBA), Alma Mater Studiorum University of Bologna, Bologna, Italy
Hepatology is an area where the prescription of albumin is recommended by international guidelines. In fact, randomized clinical trials and metanalyses have demonstrated its efficacy in preventing or treating several severe complications of cirrhosis, i.e., prevention of post-paracentesis circulatory dysfunction (PPCD) and renal failure after spontaneous bacterial peritonitis (SBP), and the diagnosis and treatment of hepatorenal syndrome (HRS) [1••, 2•, 3•] (Table 1). Two international surveys and one national survey have shown that hepatologists prescribe albumin, although not on a regular basis, also for other acute conditions not supported by solid
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