Efficacy of albumin in the treatment of alcoholic cirrhosis of the liver in combination with obesity
Annotation. Liver cirrhosis is characterized by an increase in morbidity and prevalence, life-threatening complications, disability and increased mortality of the working population. The aim of the study was to study the effect of albumin on the course of alcoholic liver cirrhosis in combination with obesity at the stage of decompensation. The study included 52 patients with alcoholic liver cirrhosis in combination with obesity (confirmed before the onset of ascites) with the primary uncomplicated ascites of 2-3 degrees, 46 men and 6 women aged 35 to 59 years; 32 patients were diagnosed with class B and 20 – with class C according to the Child-Pugh score. Depending on the treatment, patients were divided into 2 groups: Group I included 26 patients who received in their combination therapy albumin 40.0 g/week for 2 weeks of inpatient treatment and 20.0 g/week for 12 weeks of outpatient treatment, followed by a maintenance dose of 20.0 g/month (10.0 g/2 weeks) for 12 weeks; 24 weeks after the start of treatment, 16 patients gave their consent and continued maintenance therapy for another 24 weeks. Group II included 26 patients who received basic therapy without albumin. Assessment of patients was performed before treatment, 12, 24, 48 weeks after treatment onset; in 96 weeks – according to medical documentation. Statistical processing of the results was performed using software Microsoft Excel spreadsheet and application package Statistica v. 12.0 StatSoft, USA. In patients with alcoholic liver cirrhosis in combination with obesity, the inclusion in the complex therapy of long-term use of albumin improves the course of the disease according to the Child-Pugh score, MELD, DMF and CLIF-SOFA indices. There was a reduce the recurrence of ascites, the number of complications, a re-hospitalization within a year, an increase in the survival of patients within 48 months. No side effects of albumin were noted. Thus, long-term use of albumin in complex treatment of patients with alcoholic liver cirrhosis in combination with obesity contributes to an increase in the effectiveness of treatment.
2. Ministry of Health of Ukraine. (2014). Unifikovanyi klinichnyi protokol pervynnoi, vtorynnoi (spetsializovanoi) medychnoi dopomohy "Alkoholnyi steatohepatyt" [Unified clinical protocol primary, secondary (specialized) medical care "Alcoholic steatohepatitis"]. Ministry of Health of Ukraine. Order № 826.
3. Ministry of Health of Ukraine. (2014). Unifikovanyi klinichnyi protokol pervynnoi, vtorynnoi (spetsializovanoi) medychnoi dopomohy "Nealkoholnyi steatohepatyt" [Unified clinical protocol primary, secondary (specialized) medical care "Non-alcoholic steatohepatitis]. Ministry of Health of Ukraine. Order № 826.
4. Okusok, O. M., Hryshchuk, L. A., Zhulkevych, I. V., & Tabas, P. S. (2017). Vykorystannia biokhimichnykh markeriv ta kompiuternoi tomohrafii u diahnostytsi urazhen pechinky pry tuberkulozi lehen [Use of biochemical markers and computed tomography in the diagnosis of liver disease in pulmonary tuberculosis]. Visnyk naukovykh doslidzhen – Bulletin of Scientific Research, 4, 33–36.
5. Alcaraz‐Quiles, J., Casulleras, M., Oettl, K., Titos, E., Flores‐Costa, R., Duran‐Güell, M., ... & Clària, J. (2018). Oxidized albumin triggers a cytokine storm in leukocytes through p38 Mitogen‐Activated protein kinase: role in systemic inflammation in decompensated cirrhosis. Hepatology, 68 (5), 1937–1952. doi: 10.1002/hep.30135
6. Bernardi, M., Angeli, P., Claria, J., Moreau, R., Gines, P., Jalan, R., ... & Trebicka, J. (2020). Albumin in decompensated cirrhosis: new concepts and perspectives. Gut, 69 (6), 1127–1138. doi: 10.1136/gutjnl-2019-318843.
7. Caraceni, P., Riggio, O., Angeli, P., Alessandria, C., Neri, S., Foschi, F. G., ... & Fagiuoli, S. (2018). Long-term albumin administration in decompensated cirrhosis (ANSWER): an open-label randomised trial. The Lancet, 391 (10138), 2417–2429. doi: 10.1016/S0140-6736(18)30840-7.
8. European Association for The Study of The Liver, & European Association for the Study of Diabetes (EASD). (2016). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. Obesity facts, 9 (2), 65–90. doi: 10.1159/000443344.
9. European Association for the Study of the Liver. (2018). EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. Journal of hepatology, 69 (2), 406–460. doi: 10.1016/j.jhep.2018.03.024.
10. European Association for the Study of the Liver. (2018). EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. Journal of hepatology, 69 (1), 154–181. doi: 10.1016/j.jhep.2018.03.018.
11. Garcia-Martinez, R., Andreola, F., Mehta, G., Poulton, K., Oria, M., Jover, M., ... & Mookerjee, R. P. (2015). Immunomodulatory and antioxidant function of albumin stabilises the endothelium and improves survival in a rodent model of chronic liver failure. Journal of hepatology, 62 (4), 799–806. doi: 10.1016/j.jhep.2014.10.031.
12. Silva, P. E. S. E., Fayad, L., Lazzarotto, C., Ronsoni, M. F., Bazzo, M. L., Colombo, B. S., ... & Schiavon, L. L. (2015). Single‐centre validation of the EASL‐CLIF Consortium definition of acute‐on‐chronic liver failure and CLIF‐SOFA for prediction of mortality in cirrhosis. Liver International, 35 (5), 1516–1523. doi: 10.1111/liv.12597.
13. Singal, A. K., Bataller, R., Ahn, J., Kamath, P. S., & Shah, V. H. (2018). ACG clinical guideline: alcoholic liver disease. The American journal of gastroenterology, 113 (2), 175–194. doi: 10.1038/ajg.2017.469.
14. Walayat, S., Martin, D., Patel, J., Ahmed, U., N. Asghar, M., Pai, A. U., & Dhillon, S. (2017). Role of albumin in cirrhosis: from a hospitalist’s perspective. Journal of community hospital internal medicine perspectives, 7 (1), 8–14. doi: 10.1080/20009666.2017.1302704.
15. World Health Organization. (2018). Primary health care and health emergencies (No. WHO/HIS/SDS/2018.52). World Health Organization.
This work is licensed under a Creative Commons Attribution 4.0 International License.