Albumin Use in Liver Cirrhosis

Proven applications

Possible applications

Strong evidence

Lack of strong evidence but physiological rationale

Large-volume paracentesis

Recurrent ascites (as a long-term treatment)

Spontaneous bacterial peritonitis (SBP) with ascites

Non-SBP-related sepsis and infections

Hepatorenal syndrome (concomitantly with diuretics and/or vasoconstrictors)

Hypervolemic hyponatremia

Hepatic encephalopathy

Detoxification (as extracorporeal blood purification)

Table 6.2

Albumin functions

Main property	Its relation to albumin structure	Mechanism description
Regulation of oncotic pressure	Constitutes 50 % of total plasma proteins Has net negative charge at physiological pH	Represents 70–80 % of the plasma oncotic pressure Increases intravascular blood volume
Transportation and metabolism	Has net negative charge at physiological pH Has complex flexible tertiary structure with binding sites	Has capacity to bind various endo- and exogenous substances and molecules (bilirubin, metals, ions, hormones, amino acids, fatty acids, bile acids, nitric oxide, drugs, endotoxin)
Additional property
Capillary permeability stabilization	In 50 % is present in extravascular compartment	Influences vascular integrity
Antioxidative effect	Contains sulfhydryl (thiol) groups	Scavenges free radicals Neutralizes ionic catalyzers (copper and iron)
Hemostatic effect	Has complex flexible tertiary structure with binding sites	Binds and inactivates nitric oxide and arachidonic acid Interferes platelet aggregation Neutralizes factor Xa by AT
Acid-base regulation	Has net negative charge at physiological pH	Buffers plasma
Immunomodulation	Has complex flexible tertiary structure with binding sites Contains sulfhydryl (thiol) groups	Binds and inactivates endotoxin Inhibits and regulates production of TNF-α, NF-ĸB, complement factor C5a Interferes neutrophil adhesion
Endothelial stabilization	Has complex flexible tertiary structure with binding sites Contains sulfhydryl (thiol) groups Has net negative charge at physiological pH	Regulates metabolic function of substances released to circulation Modulates inflammation and oxidative stress Inhibits apoptosis
Pleiotropic effect	Has complex flexible tertiary structure with binding sites	Prevents myocardial damage Stabilizes endothelial cells

6.4 Therapeutic Use

Albumin can be administrated via the transfusion of plasma products or HSA, which is preferred. There are several albumin solutions in the market: 4 %, 5 %, 20 %, and 25 %, containing 0.04 g, 0.05 g, 0.2 g, and 0.25 g of albumin per ml, respectively.

In healthy subjects, approximately 66 % of the extracellular albumin is in the interstitial space and only 1/3 in the intravascular space. The transfer from the intravascular to interstitial space is 4–5 % per hour, and approximately a parallel transfer exists from the interstitial compartment into the lymphatic system. In patients with liver cirrhosis who undergo albumin transfusion, those ratios are difficult to estimate because of a much more complex albumin metabolism which depends on the degree of organ failure and systemic inflammation. The therapeutic action of HSA in cirrhosis is believed to arise not only from the plasma volume expansion but also from the modulation of systemic and organ inflammation [6].

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