title: Effect of intravenous albumin on endotoxin removal, cytokines, and nitric oxide production in patients with cirrhosis and spontaneous bacterial peritonitis.
abstract: OBJECTIVE
  In patients with cirrhosis and spontaneous bacterial peritonitis (SBP), the use of intravenous albumin has been shown to prevent deterioration of renal function and to decrease the mortality rate, but the mechanisms remain unclear. The purpose of this study was to characterize the mechanisms of action of albumin with the focus on endotoxin and cytokines.
  
  
  METHODS
  Thirty patients with SBP were divided into two groups. Group 1 received antibiotics and albumin infusion (20% 50 cc every day for 3 days) and Group 2 received antibiotic treatment only. Twenty-four cirrhotic patients with sterile ascites were enrolled in Group 3 and received albumin infusion (20% 50 cc every day for 3 days). Plasma and ascitic fluid concentrations of endotoxin, nitric oxide products (NOx), tumor necrosis factor (TNF)-alpha, and interleukin (IL)-6 were analyzed before and after treatments, respectively.
  
  
  RESULTS
  Combination therapy of albumin and antibiotics can significantly (p<0.01) reduce plasma levels of TNF-alpha and IL-6, and ascitic fluid levels of endotoxin, TNF-alpha and IL-6 in cirrhotic patients with SBP. Without the addition of albumin to an antibiotic regimen, the plasma and ascitic fluid levels of NOx increased significantly in patients with SBP (p=0.005 and p=0.004, respectively).
  
  
  CONCLUSIONS
  The results confirm that the beneficial effects of albumin are related to the reduction of the levels of TNF-alpha and NOx in both plasma and ascitic fluid. The infusion of albumin continuously for 3 days in addition to antibiotic treatment at the time of SBP detection is recommended as an effective therapy for patients with cirrhosis and SBP.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Taiwan.
authors.forename: Tai-An
authors.initials: TA
authors.lastname: Chen
authors.forename: Yu-Chen
authors.initials: YC
authors.lastname: Tsao
authors.forename: Angela
authors.initials: A
authors.lastname: Chen
authors.forename: Gin-Ho
authors.initials: GH
authors.lastname: Lo
authors.forename: Chiun-Ku
authors.initials: CK
authors.lastname: Lin
authors.forename: Hsien-Chung
authors.initials: HC
authors.lastname: Yu
authors.forename: Lung-Chih
authors.initials: LC
authors.lastname: Cheng
authors.forename: Ping-I
authors.initials: PI
authors.lastname: Hsu
authors.forename: Wei-Lun
authors.initials: WL
authors.lastname: Tsai
mesh_terms: D000368:Aged; D000418:Albumins / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy; D015415:Biomarkers / Q000032:analysis; D016207:Cytokines / Q000032:analysis / Q000378:metabolism*; D004359:Drug Therapy, Combination; D004731:Endotoxins / Q000097:blood / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D015850:Interleukin-6 / Q000097:blood; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000096:biosynthesis; D010538:Peritonitis / Q000188:drug therapy* / Q000382:microbiology; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D000418:Albumins; D000900:Anti-Bacterial Agents; D015415:Biomarkers; D016207:Cytokines; D004731:Endotoxins; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D009569:Nitric Oxide