Albumin in decompensated cirrhosis: new concepts and perspectives

The pathophysiological background of decompensated cirrhosis is characterised by a systemic proinflammatory and pro-oxidant milieu that plays a major role in the development of multiorgan dysfunction. Such abnormality is mainly due to the systemic spread of bacteria and/or bacterial products from th...

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Autores: Bernardi, Mauro, Angeli, Paolo, Clària i Enrich, Joan, Moreau, Richard, Ginès i Gibert, Pere, Jalan, Rajiv, Caraceni, Paolo, Fernández, Javier, Gerbes, Alexander L., O'Brien, Alastair J., Trebicka, Jonel, Thevenot, Thierry, Arroyo, Vicente
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2020
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/173020
Acceso en línea:https://hdl.handle.net/2445/173020
Access Level:acceso abierto
Palabra clave:Cirrosi hepàtica
Albúmines
Hepatic cirrhosis
Albumins
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spelling Albumin in decompensated cirrhosis: new concepts and perspectivesBernardi, MauroAngeli, PaoloClària i Enrich, JoanMoreau, RichardGinès i Gibert, PereJalan, RajivCaraceni, PaoloFernández, JavierGerbes, Alexander L.O'Brien, Alastair J.Trebicka, JonelThevenot, ThierryArroyo, VicenteCirrosi hepàticaAlbúminesHepatic cirrhosisAlbuminsThe pathophysiological background of decompensated cirrhosis is characterised by a systemic proinflammatory and pro-oxidant milieu that plays a major role in the development of multiorgan dysfunction. Such abnormality is mainly due to the systemic spread of bacteria and/or bacterial products from the gut and danger-associated molecular patterns from the diseased liver triggering the release of proinflammatory mediators by activating immune cells. The exacerbation of these processes underlies the development of acute-on-chronic liver failure. A further mechanism promoting multiorgan dysfunction and failure likely consists with a mitochondrial oxidative phosphorylation dysfunction responsible for systemic cellular energy crisis. The systemic proinflammatory and pro-oxidant state of patients with decompensated cirrhosis is also responsible for structural and functional changes in the albumin molecule, which spoil its pleiotropic non-oncotic properties such as antioxidant, scavenging, immune-modulating and endothelium protective functions. The knowledge of these abnormalities provides novel targets for mechanistic treatments. In this respect, the oncotic and non-oncotic properties of albumin make it a potential multitarget agent. This would expand the well-established indications to the use of albumin in decompensated cirrhosis, which mainly aim at improving effective volaemia or preventing its deterioration. Evidence has been recently provided that long-term albumin administration to patients with cirrhosis and ascites improves survival, prevents complications, eases the management of ascites and reduces hospitalisations. However, variant results indicate that further investigations are needed, aiming at confirming the beneficial effects of albumin, clarifying its optimal dosage and administration schedule and identify patients who would benefit most from long-term albumin administration.BMJ Publishing Group2020info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/173020Articles publicats en revistes (Biomedicina)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.1136/gutjnl-2019-318843Gut, 2020, vol. 69, num. 6, p. 1127-1138https://doi.org/10.1136/gutjnl-2019-318843cc by-nc (c) Bernardi et al., 2020http://creativecommons.org/licenses/by-nc/3.0/es/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1730202026-05-27T06:46:51Z
dc.title.none.fl_str_mv Albumin in decompensated cirrhosis: new concepts and perspectives
title Albumin in decompensated cirrhosis: new concepts and perspectives
spellingShingle Albumin in decompensated cirrhosis: new concepts and perspectives
Bernardi, Mauro
Cirrosi hepàtica
Albúmines
Hepatic cirrhosis
Albumins
title_short Albumin in decompensated cirrhosis: new concepts and perspectives
title_full Albumin in decompensated cirrhosis: new concepts and perspectives
title_fullStr Albumin in decompensated cirrhosis: new concepts and perspectives
title_full_unstemmed Albumin in decompensated cirrhosis: new concepts and perspectives
title_sort Albumin in decompensated cirrhosis: new concepts and perspectives
dc.creator.none.fl_str_mv Bernardi, Mauro
Angeli, Paolo
Clària i Enrich, Joan
Moreau, Richard
Ginès i Gibert, Pere
Jalan, Rajiv
Caraceni, Paolo
Fernández, Javier
Gerbes, Alexander L.
O'Brien, Alastair J.
Trebicka, Jonel
Thevenot, Thierry
Arroyo, Vicente
author Bernardi, Mauro
author_facet Bernardi, Mauro
Angeli, Paolo
Clària i Enrich, Joan
Moreau, Richard
Ginès i Gibert, Pere
Jalan, Rajiv
Caraceni, Paolo
Fernández, Javier
Gerbes, Alexander L.
O'Brien, Alastair J.
Trebicka, Jonel
Thevenot, Thierry
Arroyo, Vicente
author_role author
author2 Angeli, Paolo
Clària i Enrich, Joan
Moreau, Richard
Ginès i Gibert, Pere
Jalan, Rajiv
Caraceni, Paolo
Fernández, Javier
Gerbes, Alexander L.
O'Brien, Alastair J.
Trebicka, Jonel
Thevenot, Thierry
Arroyo, Vicente
author2_role author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Cirrosi hepàtica
Albúmines
Hepatic cirrhosis
Albumins
topic Cirrosi hepàtica
Albúmines
Hepatic cirrhosis
Albumins
description The pathophysiological background of decompensated cirrhosis is characterised by a systemic proinflammatory and pro-oxidant milieu that plays a major role in the development of multiorgan dysfunction. Such abnormality is mainly due to the systemic spread of bacteria and/or bacterial products from the gut and danger-associated molecular patterns from the diseased liver triggering the release of proinflammatory mediators by activating immune cells. The exacerbation of these processes underlies the development of acute-on-chronic liver failure. A further mechanism promoting multiorgan dysfunction and failure likely consists with a mitochondrial oxidative phosphorylation dysfunction responsible for systemic cellular energy crisis. The systemic proinflammatory and pro-oxidant state of patients with decompensated cirrhosis is also responsible for structural and functional changes in the albumin molecule, which spoil its pleiotropic non-oncotic properties such as antioxidant, scavenging, immune-modulating and endothelium protective functions. The knowledge of these abnormalities provides novel targets for mechanistic treatments. In this respect, the oncotic and non-oncotic properties of albumin make it a potential multitarget agent. This would expand the well-established indications to the use of albumin in decompensated cirrhosis, which mainly aim at improving effective volaemia or preventing its deterioration. Evidence has been recently provided that long-term albumin administration to patients with cirrhosis and ascites improves survival, prevents complications, eases the management of ascites and reduces hospitalisations. However, variant results indicate that further investigations are needed, aiming at confirming the beneficial effects of albumin, clarifying its optimal dosage and administration schedule and identify patients who would benefit most from long-term albumin administration.
publishDate 2020
dc.date.none.fl_str_mv 2020
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/173020
url https://hdl.handle.net/2445/173020
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1136/gutjnl-2019-318843
Gut, 2020, vol. 69, num. 6, p. 1127-1138
https://doi.org/10.1136/gutjnl-2019-318843
dc.rights.none.fl_str_mv cc by-nc (c) Bernardi et al., 2020
http://creativecommons.org/licenses/by-nc/3.0/es/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc by-nc (c) Bernardi et al., 2020
http://creativecommons.org/licenses/by-nc/3.0/es/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv BMJ Publishing Group
publisher.none.fl_str_mv BMJ Publishing Group
dc.source.none.fl_str_mv Articles publicats en revistes (Biomedicina)
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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