Effect of intravenous albumin on endotoxin removal, cytokines, and nitric oxide production in patients with cirrhosis and spontaneous bacterial peritonitis.
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.
Chen
Tai-An
TA
Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Taiwan.
Tsao
Yu-Chen
YC
Chen
Angela
A
Lo
Gin-Ho
GH
Lin
Chiun-Ku
CK
Yu
Hsien-Chung
HC
Cheng
Lung-Chih
LC
Hsu
Ping-I
PI
Tsai
Wei-Lun
WL
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
D000418:Albumins; D000900:Anti-Bacterial Agents; D015415:Biomarkers; D016207:Cytokines; D004731:Endotoxins; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D009569:Nitric Oxide