Albúmina en cirrosis: perspectiva inflamatoria
DOI:
https://doi.org/10.59093/27112330.100Palabras clave:
albúmina sérica humana, cirrosis hepática, falla hepática aguda sobre crónica, inflamación, ascitis.Resumen
La albúmina sérica humana es la proteína más abundante en el plasma, su estructura molecular le confiere estabilidad, pero también flexibilidad para ligar y transportar un amplio rango de moléculas. Su función oncótica es la propiedad más reconocida que la lleva a introducirse en la terapéutica médica como un expansor de volumen. Sin embargo, en los últimos años se le han adicionado funciones con carácter antioxidante, inmunomodulador y de estabilización endotelial, que hacen presumir que su impacto terapéutico está más allá de sus funciones volumétricas. En los últimos años, específicamente en la cirrosis y la falla hepática aguda sobre crónica, se ha tenido un cambio en el paradigma fisiológico, desde una perspectiva netamente hemodinámica hacia una perspectiva inflamatoria, en donde las funciones oncóticas y no oncóticas de la albúmina están alteradas y tienen un carácter pronóstico en estas entidades. Este conocimiento creciente, desde una perspectiva inflamatoria, hace que se fortalezca el uso terapéutico de la albúmina sérica humana desde las indicaciones tradicionales como prevención de la disfunción circulatoria posparacentesis, prevención y tratamiento de lesión renal aguda, hasta las discusiones para administración a largo plazo en pacientes cirróticos con ascitis.
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Referencias bibliográficas
Arroyo V, García-Martínez R, Salvatella X. Human serum albumin, systemic inflammation, and cirrhosis. J Hepatol 2014;61:396-407. https://doi.org/10.1016/j.jhep.2014.04.012.
Bernardi M, Angeli P, Claria J, Moreau R, Gines P, Jalan R, et al. Albumin in decompensated cirrhosis: New concepts and perspectives. Gut 2020;69:1127-1138. https://doi.org/10.1136/gutjnl-2019-318843.
Bernardi M, Moreau R, Angeli P, Schnabl B, Arroyo V. Mechanisms of decompensation and organ failure in cirrhosis: From peripheral arterial vasodilation to systemic inflammation hypothesis. J Hepatol 2015;63:1272-1284. https://doi.org/10.1016/j.jhep.2015.07.004.
Arroyo V, Moreau R, Kamath PS, Jalan R, Ginès P, Nevens F, et al. Acute-on-chronic liver failure in cirrhosis. Nat Rev Dis Primers. 2016;2: 16041. https://doi.org/10.1038/nrdp.2016.41.
Garcia-Martinez R, Caraceni P, Bernardi M, Gines P, Arroyo V, Jalan R. Albumin: Pathophysiologic basis of its role in the treatment of cirrhosis and its complications. Hepatology 2013;58:1836-1846. https://doi.org/10.1002/hep.26338.
Tufoni M, Baldassarre M, Zaccherini G, Antognoli A, Caraceni P. Hemodynamic and systemic effects of albumin in patients with advanced liver disease. Curr Hepatol Rep 2020;19:147-158. https://doi.org/10.1007/s11901-020-00521-1.
Fanali G, Di Masi A, Trezza V, Marino M, Fasano M, Ascenzi P. Human serum albumin: from bench to bedside. Mol Asp Med 2012;33:209-90. https://doi.org/10.1016/j.mam.2011.12.002.
Quinlan GJ, Martin GS, Evans TW. Albumin: biochemical properties and therapeutic potential. Hepatology 2005;41:1211-1219. https://doi.org/10.1002/hep.20720.
Oettl K, Marsche G. Redox state of human serum albumin in terms of cysteine-34 in health and disease. Methods Enzymol 2010;474: 181-95. https://doi.org/10.1016/S0076-6879(10)74011-8.
Naldi M, Baldassarre M, Domenicali M, Bartolini M, Caraceni P. Structural and functional integrity of human serum albumin: analytical approaches and clinical relevance in patients with liver cirrhosis. J Pharm Biomed Anal 2017;144:138-53. https://doi.org/10.1016/j.jpba.2017.04.023.
Spinella R, Sawhney R, Jalan R. Albumin in chronic liver disease: Structure, functions and therapeutic implications. Hepatol Int 2015;10:124-132. https://doi.org/10.1007/s12072-015-9665-6.
Kragh-Hansen U, Chuang VT, Otagiri M. Practical aspects of the ligand-binding and enzymatic properties of human serum albumin. Biol Pharm Bull 2002;25:695-704. https://doi.org/10.1248/bpb.25.695.
Gioannini TL, Zhang DS, Teghanemt A, Weiss JP. An essential role for albumin in the interaction of endotoxin with lipopolysaccharide-binding protein and sCD14 and resultant cell activation. J Biol Chem 2002;277:47818-47825. https://doi.org/10.1074/jbc.M206404200.
Yang J, Petersen CE, Ha C-E, Bhagavan NV. Structural insights into human serum albumin-mediated prostaglandin catalysis. Protein Sci 2009;11:538545. https://doi.org/10.1110/ps.28702.
Di Masi A, Leboffe L, Polticelli F, Tonon F, Zennaro C, Caterino M, et al. Human serum albumin is an essential component of the host defense mechanism against Clostridium difficile intoxication. J Infect Dis 2018;218:1424-1435. https://doi.org/10.1093/infdis/jiy338.
Kremer H, Baron-Menguy C, Tesse A, Gallois Y, Mercat A, Henrion D, et al. Human serum albumin improves endothelial dys- function and survival during experimental endotoxemia: concentration-dependent properties. Crit Care Med 2011;39: 1414-1422. https://doi.org/10.1097/CCM.0b013e318211ff6e.
D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol 2006;44:217-231. https://doi.org/10.1016/j.jhep.2005.10.013.
Møller S, Bendtsen F. The pathophysiology of arterial vasodilatation and hyperdynamic circulation in cirrhosis. Liver Int 2018;38:570-580. https://doi.org/10.1111/liv.13589.
Hennenberg M, Trebicka J, Sauerbruch T, Heller J. Mechanisms of extrahepatic vasodilation in portal hypertension. Gut 2008;57:1300-1314. https://doi.org/10.1136/gut.2007.144584.
Solà E, Ginès P. Renal and circulatory dysfunction in cirrhosis: current management and future perspectives. J Hepatol 2010;53:1135-1145. https://doi.org/10.1016/j.jhep.2010.08.001.
Tsochatzis EA, Gerbes AL. Diagnosis and treatment of ascites. J Hepatol 2017;67:184-185. https://doi.org/10.1016/j.jhep.2017.01.011.
Tilg H, Wilmer A, Vogel W, Herold M, Nölchen B, Judmaier G, et al. Serum levels of cytokines in chronic liver diseases. Gastroenterology 1992;103:264-274. https://doi.org/10.1016/0016-5085(92)91122-k.
Albillos A, Lario M, Álvarez-Mon M. Cirrhosis-associated immune dysfunction: distinctive features and clinical relevance. J Hepatol 2014;61:1385-1396. https://doi.org/10.1016/j.jhep.2014.08.010.
Trebicka J, Amorous A, Pitarch C, Titos E, Alcaraz-Quiles J, Schierwagen R, et al. Addressing profiles of systemic inflammation across the different clinical phenotypes of acutely decompensated cirrhosis. Front Immunol 2019;10:476. https://doi.org/10.3389/fimmu.2019.00476.
Clària J, Stauber RE, Coenraad MJ, Moreau R, Jalan R, Pavesi M, et al. Systemic inflammation in decompensated cirrhosis: characterization and role in acute-on-chronic liver failure. Hepatology 2016;64:1249-1264. https://doi.org/10.1002/hep.28740.
Solé C, Solà E, Morales-Ruiz M, Fernàndez G, Huelin P, Graupera I, Moreira R, et al. Characterization of inflammatory response in acute-on-chronic liver failure and relationship with prognosis. Sci Rep 2016;6:32341. https://doi.org/10.1038/srep32341.
Wiest R, Lawson M, Geuking M. Pathological bacterial translocation in liver cirrhosis. J Hepatol 2014;60:197-209. https://doi.org/10.1016/j.jhep.2013.07.044.
Kubes P, Mehal WZ. Sterile inflammation in the liver. Gastroenterology 2012;143:1158-1172. https://doi.org/10.1053/j.gastro.2012.09.008.
Iwakiri Y, Groszmann RJ. The hyperdynamic circulation of chronic liver diseases: from the patient to the molecule. Hepatology 2006;43:S121-131 https://doi.org/10.1002/hep.20993.
Oettl K, Birner-Gruenberger R, Spindelboeck W, Stueger HP, Dorn L, Stadlbauer V, et al. Oxidative albumin damage in chronic liver failure: relation to albumin binding capacity, liver dysfunction and survival. J Hepatol 2013;56:978-983. https://doi.org/10.1016/j.jhep.2013.06.013.
O’Brien AJ, Fullerton JN, Massey KA, Auld G, Sewell G, James S, et al. Immunosuppression in acutely decompensated cirrhosis is mediated by prostaglandin E2. Nat Med 2014;20:1-8. https://doi.org/10.1038/nm.3516.
Alcaraz-Quiles J, Casulleras M, Oettl K, Titos E, Flores-Costa R, Duran-Güell M, et al. Oxidized albumin triggers a cytokine storm in leukocytes through p38 MAP kinase: role in systemic inflammation in decompensated cirrhosis. Hepatology. 2018;68:1937-1952. https://doi.org/10.1002/hep.30135.
China L, Maini A, Skene SS, Shabir Z, Sylvestre Y, Colas RA, et al. Albumin counteracts immune-suppressive effects of lipid mediators in patients with advanced liver disease. Clin Gastroenterol Hepatol 2018;16:738-747. https://doi.org/10.1016/j.cgh.2017.08.027.
Domenicali M, Baldassarre M, Giannone FA, Naldi M, Mastroroberto M, Biselli M, et al. Posttranscriptional changes of serum albumin: clinical and prognostic significance in hospitalized patients with cirrhosis. Hepatology. 2014;60:1851-1860. https://doi.org/10.1002/hep.27322.
Angeli P, Bernardi M, Villanueva C, Francoz C, Mookerjee RP, Trebicka J, et al. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69:406-460. https://doi.org/10.1016/j.jhep.2018.03.024.
Pozzi M, Osculati G, Boari G, Serboli P, Colombo P, Lambrughi C, et al. Time course of circulatory and humoral effects of rapid total paracentesis in cirrhotic patients with tense, refractory ascites. Gastroenterology 1994;106:709-719. https://doi.org/10.1016/0016-5085(94)90706-4.
Ruiz del Arbol L, Monescillo A, Jimenez W, et al. Paracentesis-induced circulatory dysfunction: mechanism and effect on hepatic hemodynamics in cirrhosis. Gastroenterology 1997;113:579-586. https://doi.org/10.1053/gast.1997.v113.pm9247479.
Ginès P, Tito LV, Arroyo V, et al. Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis. Gastroenterology 1988;94: 1493-1502. https://doi.org/10.1016/0016-5085(88)90691-9.
Sola-Vera J, Miñana J, Ricart E, et al. Randomized trial comparing albumin and saline in the prevention of paracentesis-induced circulatory dysfunction in cirrhotic patients with ascites. Hepatology 2003;37:1147-1153. https://doi.org/10.1053/jhep.2003.50169.
Abdel-Khalek EE, Arif SE. Randomized trial comparing human albumin and hydroxyethyl starch 6% as plasma expanders for treatment of patients with liver cirrhosis and tense ascites following large volume paracentesis. Arab J Gastroenterol 2010;11:24-29. https://doi.org/10.1016/j.ajg.2010.01.006.
Bernardi M, Caraceni P, Navickis RJ, Wilkes MM. Albumin infusion in patients undergoing large-volume paracentesis: A meta-analysis of randomized trials. Hepatology 2012;55:1172-1181. https://doi.org/10.1002/hep.24786.
Caraceni P, Angeli P, Prati D, Bernardi M, Alessandria C, Riggio O, et al. AISF-SIMTI position paper: The appropriate use of albumin in patients with liver cirrhosis. Digestive and Liver Disease 2016;48:4-15. https://doi.org/10.1016/j.dld.2015.11.008.
Follo A, Love JM, Navasa M, Planas R, Forns X, Francitorra A, et al. Renal impairment after spontaneous bacterial peritonitis in cirrhosis: incidence, clinical course, predictive factors and prognosis. Hepatology 1994; 20:1495-1501. https://doi.org/10.1002/hep.1840200619.
Tandon P, Garcia-Tsao G. Renal dysfunction is the most important independent predictor of mortality in cirrhotic patients with spontaneous bacterial peritonitis. Clin Gastroenterol Hepatol 2011; 9: 260-5. https://doi. org/0.1016/j.cgh.2010.11.038
Ruiz-del Arbol L, Urman J, Fernández J, et al. Systemic, renal, and hepatic hemodynamic derangement in cirrhotic patients with spontaneous bacterial peritonitis. Hepatology 2003; 38: 1210-1218. https://doi.org/10.1053/jhep.2003.50447.
Fernández J, Monteagudo J, Bargallo X, Jiménez W, Bosch J, Arroyo V, et al. A randomized unblinded pilot study comparing albumin versus hydroxyethyl starch in spontaneous bacterial peritonitis. Hepatology 2005;42:627-634. https://doi.org/10.1002/hep.20829.
Sort P, Navasa M, Arroyo V, Aldeguer X, Planas R, Ruiz-del Arbol L, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med 1999;341:403-409. https://doi.org/10.1056/nejm199908053410603.
Salerno F, Navickis RJ, Wilkes MM. Albumin infusion improves outcomes of patients with spontaneous bacterial peritonitis: A meta-analysis of randomized trials. Clin Gastroenterol Hepatol 2013;11:123-130. https://doi.org/10.1016/j.cgh.2012.11.007.
Simonetto DA, Gines P, Kamath PS. Hepatorenal syndrome: pathophysiology, diagnosis, and management. BMJ 2020;370:m2687. https://doi.org/10.1136/bmj.m2687.
Moreau R, Lebrec D. The use of vasoconstrictors in patients with cirrhosis: type 1 HRS and beyond. Hepatology 2006;43:385-394. https://doi.org/10.1002/hep.21094.
Allegretti AS, Israelsen M, Krag A, Jovani M, Goldin AH, Schulman AR, Winter RW, Gluud LL. Terlipressin versus placebo or no intervention for people with cirrhosis and hepatorenal syndrome. Cochrane Database Syst Rev 2017;6:CD005162. https://doi.org/10.1002/14651858.CD005162.pub4.
Israelsen M, Krag A, Allegretti AS, Jovani M, Goldin AH, Winter RW, Gluud LL. Terlipressin versus other vasoactive drugs for hepatorenal syndrome. Cochrane Database Syst Rev 2017;9:CD011532. https://doi.org/10.1002/14651858.CD011532.pub2.
Wang H, Liu A, Bo W, Feng X, Hu Y. Terlipressin in the treatment of hepatorenal syndrome: A systematic review and meta-analysis. Medicine 2018;97:e0431. https://doi.org/10.1097/MD.0000000000010431.
Caraceni P, Riggio O, Angeli P, Alessandria C, Neri S, Foschi FG, et al. Long-term albumin administration in decompensated cirrhosis (ANSWER): An open-label randomised trial. Lancet 2018;391:2417-2429. https://doi.org/10.1016/s0140-6736(18)30840-7.
Solà E, Solé C, Simón-Talero M, Martín-Llahí M, Castellote J, Garcia-Martínez R, et al. Midodrine and albumin for prevention of complications in patients with cirrhosis awaiting liver transplantation. A randomized placebo-controlled trial. J Hepatology 2018;69:1250-1259. https://doi.org/10.1016/j.jhep.2018.08.006.
González-Domínguez EH, Marín-Tirado HA, Torres-Cueva GA. Uso de albúmina a largo plazo en el paciente cirrótico. Revisión sistemática. Hepatología 2023;4:25-36. https://doi.org/10.52784/27112330.164.
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