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    Home > Active Ingredient News > Digestive System Information > Liver cirrhosis - your sentimental "feeling", human serum albumin to "smooth"

    Liver cirrhosis - your sentimental "feeling", human serum albumin to "smooth"

    • Last Update: 2022-01-25
    • Source: Internet
    • Author: User
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    *For medical professionals to read and refer to the application of human serum albumin in liver cirrhosis complicated by infection Cirrhosis is the most common infection
    .

    According to statistics, the probability of infection in patients with liver cirrhosis at the time of admission or during hospitalization is 25% to 35%, which is 4 to 5 times that of the general population
    .

    The probability of co-infection in patients with decompensated liver cirrhosis can even be as high as 62%, and the mortality rate can be increased by 3.
    75 times after bacterial infection in patients at this stage [1-3]
    .

    Once the liver cirrhosis is complicated with infection, the liver damage will show a progressive aggravation trend, and it is easy to induce upper gastrointestinal bleeding, liver Serious complications such as encephalopathy, hepatorenal syndrome (HRS), etc.
    , are also the reason for the significantly increased mortality
    .

    According to statistics, the mortality rate of patients with liver cirrhosis at 1 month, 3 months and 1 year after infection was 19.
    9 %~30%, 35.
    1% and 63%[1]
    .

    ” Therefore, for patients with liver cirrhosis, the high-risk factors for infection should be evaluated as soon as possible, and early prevention, timely diagnosis and reasonable treatment should be combined to minimize the occurrence of infection caused by infection.
    adverse consequences
    .

    Why are patients with liver cirrhosis prone to infection? What are the risk factors? When liver cirrhosis progresses to the decompensated stage, liver function is significantly reduced, and patients will experience microcirculation disorders, impaired barrier function, microecological imbalance, flora translocation, endotoxemia, and local and systemic inflammatory responses in the liver.
    Patients are prone to infection [2]
    .

    The main risk factors for infection in patients with liver cirrhosis include: severely impaired liver function, impaired intestinal barrier function, dysbiosis of intestinal flora, acquired or inherited immunodeficiency, esophagogastric varices bleeding due to portal hypertension, Ascites protein levels are low [1]
    .

    In addition, some data show that the longer the hospital stay, the worse the liver function, the lower the white blood cell level, the higher the risk of co-infection in patients with liver cirrhosis [3]
    .

    What is the role of human serum albumin in the treatment of liver cirrhosis complicated by infection? Studies have confirmed that the use of human albumin therapy can significantly improve systemic hemodynamics in patients with cirrhosis and SBP, and significantly reduce the incidence of renal injury and mortality [4-5]
    .

    A randomized, open-label clinical study of 20 patients with liver cirrhosis and SBP who were randomly divided into 20% albumin treatment group (n=10) and 6% hydroxyethyl starch treatment group (n=10)
    .

    The researchers tested the patients' hemodynamics, liver function, renal function and other indicators within 12 hours after the infection was diagnosed, and then grouped them for treatment, and re-measured the indicators after the infection was eliminated
    .

    The results showed that compared with the hydroxyethyl starch treatment group, the patients in the albumin treatment group had a more significant increase in arterial pressure, more obvious inhibition of plasma renin activity, and better improvement of circulatory function
    .

    Therefore, it is concluded that albumin therapy can significantly improve the related indicators of systemic hemodynamics in patients with liver cirrhosis and SBP, thereby improving the function of the circulatory system [4]
    .

    A randomized controlled study confirmed that human serum albumin treatment can significantly reduce the incidence of renal injury and mortality in patients with cirrhosis and SBP
    .

    A total of 126 patients with liver cirrhosis and SBP were included in this study and randomly divided into two groups.
    The study group (n=63) was given intravenous cefotaxime + albumin (dose of 1.
    5 g/kg, starting from the third day).
    changed to 1 g/kg), and the control group (n=63) was only given cefotaxime intravenously
    .

    The results showed that compared with antibiotics alone, the incidence of renal injury and in-hospital mortality in patients treated with albumin combined with antibiotics were significantly lower [5]
    .

    How does the guideline recommend the use of human serum albumin for liver cirrhosis complicated by infection? The "Guidelines for the Diagnosis and Treatment of Liver Cirrhosis (2019)" recommends that for patients with sepsis and severe infection, high-dose human albumin can be given at the same time as antibiotics, and vasoactive drugs should be added when low blood pressure [6]
    .

    The "Quick Recommendation Guidelines for the Use of Human Albumin in the Treatment of Liver Cirrhosis" also recommends that human albumin be used to reduce the mortality of patients with liver cirrhosis complicated by severe infection [7]
    .

    Regarding the dosage, it is stated in the "Quick Recommendation Guidelines for Human Serum Albumin for the Treatment of Liver Cirrhosis" that the recommended dosage of albumin in foreign studies is: 1.
    5 g/kg on the first day, and 1 g/kg on the third day ; In domestic studies, the dosage regimen of human albumin is 0.
    5-1.
    0 g/kg on the 1st day, the 3rd day and every 3 days after that.
    In clinical practice, individualized treatment must be combined with the specific situation [7] ]
    .

    Conclusion Patients with cirrhosis are prone to infection due to microcirculation disturbance, impaired barrier function, microecological imbalance, bacterial translocation, endotoxemia, local and systemic inflammatory response in the liver, etc.
    Serious complications, including hemorrhage, hepatic encephalopathy, and HRS, increase the risk of death
    .

    Therefore, for patients with liver cirrhosis, prevention and treatment of infection is very important
    .

    Studies have confirmed that human albumin therapy can significantly improve systemic hemodynamics in patients with SBP, and significantly reduce the incidence of renal injury and mortality in patients with SBP
    .

    The guidelines also pointed out that for patients with sepsis and severe infection, high-dose human serum albumin can be given at the same time as antibacterial drugs, and vasoactive drugs should be added when low blood pressure; Mortality in patients with sclerosis complicated by severe infection
    .

    References: [1] Nan Yuemin, Niu Xuemin.
    Early recognition and empirical treatment of liver cirrhosis complicated by infection [J].
    Journal of Clinical Hepatobiliary Diseases, 2015, 31(03): 349-353.
    [2] Ma Luyuan, Li Xingyu , Zhao Caiyan.
    Advances in the diagnosis and treatment of liver cirrhosis complicated with infection[J].
    Clinical Metadata, 2018,33(11):925-928.
    [3]Zhang Zhi, et al.
    Clinical features and risk factors of liver cirrhosis complicated with infection Analysis[J].
    Contemporary Medicine, 2013,19(20):85-86.
    [4]Fernández J, et al.
    A Randomized Unblinded Pilot Study Comparing Albumin Versus Hydroxyethyl Starch in Spontaneous Bacterial Peritonitis.
    Hepatology.
    2005 Sep;42( 3) 627-34.
    [5] Sort P, et al.
    Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis.
    N Engl J Med 1999; 5:403-9.
    [6] Chinese Medicine Chinese Society of Hepatology.
    Guidelines for the diagnosis and treatment of liver cirrhosis[J].
    Modern Medicine and Health, 2020,36(02):320+1-18.
    [7] Li Huibo, et al.
    "Quick advice on the use of human albumin in the treatment of liver cirrhosis Interpretation of "Guidelines"[J].
    Journal of Clinical Drug Therapy,2018,16(12):10-16.
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