December 9, 2013
The Role of Albumin in Treating Patients with Cirrhosis
Atif Zaman, MD, MPH reviewing Garcia-Martinez R et al. Hepatology 2013 Nov.
As its multiple biologic functions become clearer, its therapeutic indications in liver disease continue to expand.
Intravenous albumin has historically been used as a plasma volume expander. In the current review, the authors summarize other potential roles of albumin, including those of antioxidant and immunomodulator, particularly within the scope of treating patients with cirrhosis.
Because of its capacity to bind a wide variety of molecules, albumin plays critical roles in solubilization, transport, and metabolism. In addition, albumin is the source of 80% of the extracellular thiols, which actively scavenge oxidative and nitrosative reactive species, making albumin the most important of the extracellular antioxidants. Its immunomodulatory properties seem to stem from its capacity to bind endotoxins, lower endotoxin activity, and inhibit tumor necrosis factor–α and nuclear factor–κβ. Albumin may also affect hemostasis by impacting platelet aggregation and influence capillary permeability by interacting with the extracellular matrix.
Well-established indications for intravenous albumin include the following:
Spontaneous bacterial peritonitis: Its addition to antibiotics reduces the incidence of renal failure and improves survival.
Hepatorenal syndrome: When added to vasoconstrictors, it decreases mortality.
Paracentesis-induced circulatory dysfunction: Albumin infusion is effective at preventing this syndrome.
Potential uses of albumin that have not yet been fully evaluated include treating severe hepatic encephalopathy and any infection in patients with cirrhosis.
Comment
This excellent review underscores that albumin is more than just a volume expander. Due to its numerous biologic functions, it has therapeutic value for many indications, particularly spontaneous bacterial peritonitis, hepatorenal syndrome, and prevention of paracentesis-induced circulatory dysfunction, conditions for which the evidence is strongest.
Editor Disclosures at Time of Publication
Citation(s):
Garcia-Martinez R et al. Albumin: Pathophysiologic basis of its role in the treatment of cirrhosis and its complications. Hepatology 2013 Nov; 58:1836. (http://dx.doi.org/10.1002/hep.26338)
