echemi logo
Product
  • Product
  • Supplier
  • Inquiry
    Home > Active Ingredient News > Digestive System Information > Global conversation: decompensated cirrhosis

    Global conversation: decompensated cirrhosis

    • Last Update: 2023-01-05
    • Source: Internet
    • Author: User
    Search more information of high quality chemicals, good prices and reliable suppliers, visit www.echemi.com



    Based on the current situation of global liver cirrhosis, authoritative liver disease experts from all over the world are invited to discuss the new progress of decompensated cirrhosis, in order to strengthen the exchange of experience and data in diagnosis and treatment at home and abroad, and promote the academic development of global decompensated cirrhosis (see the end of the conference for details).




    Cirrhosis is an important global health problem
    .
    As of 2017, there were 10.
    6 million people with decompensated cirrhosis
    and 112 million people with compensated cirrhosis globally [1].

    From 1990 to 2016, the number of people with cirrhosis and chronic liver disease in China increased from nearly 7 million to nearly 12 million [2].

    Data show that about 50% of the world's liver cancer deaths and cirrhosis deaths come from China, and China is the country with the highest burden of liver cirrhosis disease in the world [3].


    Professor Xie Qing: Current situation of liver cirrhosis


    After cirrhosis progresses to decompensated cirrhosis, patients may have complications such as ascites, spontaneous bacterial peritonitis (SBP), hepatorenal syndrome (HRS), gastrointestinal bleeding, hepatic encephalopathy and sepsis, poor clinical prognosis, and significantly increased mortality in patients with decompensated cirrhosis
    .
    Therefore, the prevention and treatment of complications is an important part of the treatment strategy of
    cirrhosis.


    With the progression of chronic liver disease or the occurrence of decompensation, liver protein synthesis ability decreases in patients with cirrhosis, resulting in a decrease in human albumin concentration and impaired function, and may be combined with a variety of complications, and the clinical prognosis is poor
    .
    Human albumin is synthesized by hepatocytes and has important functions
    of maintaining plasma colloidal osmotic pressure and increasing circulating blood volume.
    The exogenous transfusion of human albumin in the treatment of patients with cirrhosis complicated with ascites, SBP, HRS, hepatic encephalopathy and other patients has been recommended by domestic and foreign guidelines [4], and is currently commonly used in the treatment
    of these complications in clinical practice.









    Application of human albumin in the treatment of liver cirrhosis: clinical experience sharing from Europe


    PROFESSOR MAURO BERNARDI: EXPERIENCE SHARING OF LONG-TERM USE OF HUMAN ALBUMIN IN PATIENTS WITH DECOMPENSATED CIRRHOSIS


    ▌Clinical research on the long-term use of human albumin in the treatment of liver cirrhosis:



    The ANSWER study published in The Lancet in 2018 [5] has attracted widespread attention
    for the therapeutic benefits of long-term use of human albumin in patients with decompensated cirrhosis.
    This study randomised patients with cirrhosis and grade 2 to 3 ascites for 18 months, one receiving standard care (SMT) and the other adding human albumin (SMT+HA) to standard care (human albumin dose: 40 g twice weekly for the first 2 weeks and 40 g once weekly thereafter) for 18 months, with the primary endpoint of 18-month mortality
    .
    The results of this study suggest that human albumin combined with standard therapy for 18 months significantly reduces the risk of death in patients with cirrhosis by up to 38%
    compared with standard care alone.
    In addition, long-term weekly human albumin transfusions provide better control of ascites compared with standard care (see figure below).


    The ANSWER
    study was questioned by the ANSWER study in a placebo-controlled clinical trial [6] that included patients
    with decompensated cirrhosis awaiting liver transplantation 。 In this study, 173 patients with ascites were randomized to receive midodrine and human albumin (40 g/15 days) and midodrine plus placebo, with a median follow-up of 80 days, and the primary observation endpoint was complication rate; A secondary endpoint was mortality
    .
    Results showed no significant difference
    in mortality between the human albumin (40 g/15 days) + midodrine treatment group and the placebo group.
    Long-term use of human albumin did not reduce the incidence of complications of cirrhosis and improve survival
    .


    A careful comparison of the two studies, as well as a post-hoc analysis of the ANSWER study data [7], yielded convincing conclusions that the higher doses of human albumin used in the ANSWER study and that no significant clinical benefit was observed in the MACHT study related to insufficient human albumin dosage
    。 Therefore, the dose and timing of human albumin
    (human blood albumin dose: 40 g twice a week for the first 2 weeks, 40 g once a week thereafter; 18 months of treatment) is crucial in long-term treatment [8].


    Economic advantages of long-term treatment of decompensated liver cirrhosis with human albumin: ANSWER studies have shown that long-term use of human albumin is cost-effective, and that human albumin treatment reduces morbidity and reduces the need for hospitalization and length of hospital stay, thus providing economic advantages over standard medical therapy [5].


    An abstract of a study from Italy was presented at the International Liver Congress of the European Society of Hepatology in June 2022 [9], retrospectively collecting 6660 patients with cirrhosis with ascites, including 2355 patients treated with long-term human albumin therapy (LTA) + standard therapy (SMT), 4305 patients received non-LTA+SMT treatment
    .
    In patients with LTA, the average duration of treatment was 14 months, with an initial therapeutic dose of 87 g/week and subsequent maintenance of 37 g/week
    .
    The results showed that patients treated with LTA had a lower
    incidence of puncture drainage and refractory ascites.
    Other major complications (SBP, HRS, hepatic encephalopathy) were also lower
    in patients treated with LTA.
    The differences remained constant
    across age subgroups.

    The results of this study are consistent
    with the benefit data of the ANSWER study.
    Professor Mauro Bernardi believes that this shows that long-term treatment regimens with human albumin can be put into clinical practice
    .

    "EFFECTIVE HUMAN ALBUMIN CONCENTRATION" FROM CONCEPT TO CLINIC:
    PROFESSOR MARO BERNARDI: THE VALUE OF "EFFECTIVE HUMAN ALBUMIN CONCENTRATION" FROM CONCEPT TO CLINIC

    Human blood albumin is the main regulator of fluid distribution in all parts of the body, and human blood albumin not only has colloidal functions, but also many other biological functions
    .
    For example, it can bind and transport endogenous and exogenous toxin factors, human albumin is the main antioxidant in blood circulation, human albumin has the ability to regulate immunity, improve inflammatory response, and help maintain endothelial stability and protect blood vessel integrity
    .
    Unlike the colloidal functions of human albumin, these non-colloidal functions are closely related
    to the integrity of the molecular structure of human albumin.
    This aspect is also closely related
    to the diagnosis and treatment mechanism of human albumin in patients with cirrhosis.
    Patients with cirrhosis not only have reduced serum human albumin levels, but also seriously damaged the molecular structure of human albumin in the circulatory system [10].


    The proportion of intact molecules (the so-called natural human albumin subtype), as well as human albumin function, declines as cirrhosis progresses
    .
    The overall properties of human albumin are related not only to circulating levels, but also to the structural integrity of preservation – a hypothesis that has led to the development of a new concept of effective human albumin (eAlb) concentration
    .

    In 2021, we published a study in the journal Hepatology [11] that aimed to quantitatively evaluate eAlb in patients with decompensated cirrhosis and analyze its relationship
    with human albumin function and clinical outcomes 。 The study included 319 patients with cirrhosis with acute decompensation (AD) and 18 patients with compensated cirrhosis, of which 78 patients were diagnosed with chronic acute liver failure
    on admission.
    Total serum human albumin (tAlb) was quantified by standard assays, and eAlb was estimated
    by liquid chromatography-electrospray ionization-mass spectrometry and standard methods.
    Through this study, we introduced the concept of effective human albumin concentration into clinical practice
    .
    The results showed that this measurement had several advantages over routine assessment of total human albumin concentration: effective human albumin concentration did better distinguish between patients with acute decompensation and patients with chronic acute liver failure; It was an independent predictor
    of ACLF within 30 days and death within 90 days.

    In addition, there is a closer correlation between eAlb and the degree of human albumin dysfunction
    .
    These results reinforce the potential role
    of serum effective human albumin concentration in clinical practice as a biomarker for prognosis.
    It may serve as a guide to a more personalized approach – not only with regard to indications for human albumin use, but also to the use
    of drugs whose pharmacokinetic properties and efficacy may be affected by human albumin dysfunction.








    Upcoming meetings


    Conference Background:


    Based on the current status of cirrhosis disease, the platform invites authoritative liver disease experts from all over the world to discuss the new progress of decompensated cirrhosis, in order to strengthen the exchange of domestic and foreign diagnosis and treatment experience and data, and promote the academic development
    in the field of global decompensated cirrhosis.

    Conference Details: Expert Profile

    Professor Xie Qing




    • Director of Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, doctoral supervisor and second-level professor
    • Vice President of Infectious Diseases Branch of Chinese Medical Doctor Association
    • Vice Chairman of the 10th and 11th Infectious Diseases Branch of the Chinese Medical Association
    • President of the Infectious Diseases Branch of Shanghai Medical Doctor Association
    • Director of Shanghai Clinical Quality Control Center for Infectious Diseases
    • Chairman of the Infectious Diseases Branch of the 9th Shanghai Medical Association
    • Vice Chairman of Internal Medicine Branch of Shanghai Medical Association
    • Vice Chairman of the Hepatology Branch of Shanghai Medical Association
    • Vice Chairman of the Management Committee of Infectious Disease Specialized Hospital of Shanghai Hospital Association
    • Associate Editor of Chinese Journal of Infectious Diseases and Associate Editor of Liver
    • Advanced worker of the national health system, pacesetter of professional ethics in the national health system
    • Shanghai Leading Talent, Shanghai Excellent Discipline Leader, Shanghai Top Ten Public Health Workers, Five Continents
    • The Women's Science and Technology Award and the first "Medical Tree Award" enjoy the special government allowance of the State Council
    • He has published more than 300 papers in the top journals "BMJ", "Hepatology", "J Hepatology", AJG, "CID", "J Infect Dis" and other domestic core journals in the field of infection and liver diseases
    • He has won the second prize of National Science and Technology Progress Award, the first prize of Shanghai Science and Technology Progress Award, the first prize of Shanghai Medical Science and Technology Progress Award, Shanghai May Day Innovation Award, and the first prize of Huaxia Science and Technology Progress Award
      .
     Expert profiles

    Professor Mauro Bernardi


    • Professor Emeritus of Internal Medicine at the University of Bologna
    • Chairman of the Bioethics Committee of the University of Bologna
    • Vice-President, European Society of Hepatology-Chronic Liver Failure Alliance (EASL-CLIF) (2009-2019)
    • Member of the editorial boards of Alcologia, World Journal of Gastroenterology, World J Gastrointestinal Pharmacology and Therapeutics, European Medical Journal - Hepatology, etc


    References:

    [1] GBD 2017 Cirrhosis Collaborators.
    Lancet Gastroenterol Hepatol.
    2020 Mar; 5(3):245-266.

    [2] Li M,et al.
    Biomed Environ Sci.
    2020 Jan 20; 33(1):1-10.

    [3] Hepatology.
    2014 Dec; 60(6):2099-108.

    [4] Hepatology Branch of Chinese Medical Association.
    Chinese Journal of Hepatology.
    2017; 25(9):664-677

    [5] Caraceni P,et al.
    Lancet.
    2018 Jun 16; 391(10138):2417-2429.

    [6] SolàE,et al.
    J Hepatol.
    2018 Dec; 69(6):1250-1259.

    [7] Caraceni P,et al.
    Journal of Hepatology,2021,74(2):340-349.

    [8] Bernardi M,et al.
    Gut.
    2020 Jun; 69(6):1127-1138.

    [9] Wim L,et al.
    2022ILC,OS011.

    [10] Jalan,R.
    &Bernardi,M.
    J.
    Hepatol.
    59,918–920(2013).

    [11] Maurizio,B.
    et al.
    Hepatology 0,1–16(2021).


    Material approval number: VV-MEDMAT-77199

    Approved Date: November 2022
    For Healthcare Professionals

    Only Statement: This information is intended to help healthcare professionals better understand the latest developments
    in the field of related diseases.
    The content of the information released by this platform does not mean that it agrees with its description and views, and only provides more information
    .
    If copyright issues are involved, please contact us and we will deal with
    it as soon as possible.


    The information provided in this information is not in any way a substitute for professional medical guidance and should not be construed as medical advice
    .
    If such information is used for purposes other than information, the Platform, the author, and Takeda shall not be liable
    for such information.


    This article is for scientific information only to provide medical professionals and does not represent the position of
    the platform.

    This article is an English version of an article which is originally in the Chinese language on echemi.com and is provided for information purposes only. This website makes no representation or warranty of any kind, either expressed or implied, as to the accuracy, completeness ownership or reliability of the article or any translations thereof. If you have any concerns or complaints relating to the article, please send an email, providing a detailed description of the concern or complaint, to service@echemi.com. A staff member will contact you within 5 working days. Once verified, infringing content will be removed immediately.

    Contact Us

    The source of this page with content of products and services is from Internet, which doesn't represent ECHEMI's opinion. If you have any queries, please write to service@echemi.com. It will be replied within 5 days.

    Moreover, if you find any instances of plagiarism from the page, please send email to service@echemi.com with relevant evidence.