BACKGROUND AND AIMS: Circulating albumin in cirrhosis can be dysfunctional because of accumulating structural damages, leading to the concept of effective albumin concentration (eAlb), referring to the albumin portion presenting structural and functional integrity. We aimed to estimate eAlb in patients with decompensated cirrhosis and analyze its relationships with albumin function and clinical outcomes as compared to total albumin concentration (tAlb). APPROACH AND RESULTS: We evaluated 319 patients with cirrhosis hospitalized for acute decompensation (AD) with and without acute-on-chronic liver failure (ACLF) and 18 age- and sex-comparable outpatients with compensated cirrhosis. tAlb was quantified by standard assay, whereas eAlb was estimated combining liquid chromatography/electrospray ionization/mass spectrometry and standard methods. Albumin binding and detoxification efficiency were evaluated by electron paramagnetic resonance analysis. Circulating albumin in patients with decompensated cirrhosis displayed multiple structural abnormalities, with reversible oxidation and glycation being the most frequent. As a result, eAlb progressively declined with the worsening of cirrhosis and was superior to tAlb in stratifying patients between compensated cirrhosis, AD, and ACLF, as well as patients with and without complications. Moreover, eAlb, but not tAlb, was closely associated with binding capacities in ACLF. Finally, eAlb at admission predicted the occurrence of ACLF within 30 days and mortality at 90 days better than tAlb. CONCLUSIONS: This large, observational study provides the evidence in patients with decompensated cirrhosis that eAlb can be quantified and differentiated from tAlb routinely measured in clinical practice. As compared to tAlb, eAlb is more closely associated with disease severity and albumin dysfunction and carries a greater prognostic power. These results prompt future research assessing eAlb as a biomarker for predicting prognosis and treatment response.
BACKGROUND AND AIMS: Circulating albumin in cirrhosis can be dysfunctional because of accumulating structural damages, leading to the concept of effective albumin concentration (eAlb), referring to the albumin portion presenting structural and functional integrity. We aimed to estimate eAlb in patients with decompensated cirrhosis and analyze its relationships with albumin function and clinical outcomes as compared to total albumin concentration (tAlb). APPROACH AND RESULTS: We evaluated 319 patients with cirrhosis hospitalized for acute decompensation (AD) with and without acute-on-chronic liver failure (ACLF) and 18 age- and sex-comparable outpatients with compensated cirrhosis. tAlb was quantified by standard assay, whereas eAlb was estimated combining liquid chromatography/electrospray ionization/mass spectrometry and standard methods. Albumin binding and detoxification efficiency were evaluated by electron paramagnetic resonance analysis. Circulating albumin in patients with decompensated cirrhosis displayed multiple structural abnormalities, with reversible oxidation and glycation being the most frequent. As a result, eAlb progressively declined with the worsening of cirrhosis and was superior to tAlb in stratifying patients between compensated cirrhosis, AD, and ACLF, as well as patients with and without complications. Moreover, eAlb, but not tAlb, was closely associated with binding capacities in ACLF. Finally, eAlb at admission predicted the occurrence of ACLF within 30 days and mortality at 90 days better than tAlb. CONCLUSIONS: This large, observational study provides the evidence in patients with decompensated cirrhosis that eAlb can be quantified and differentiated from tAlb routinely measured in clinical practice. As compared to tAlb, eAlb is more closely associated with disease severity and albumin dysfunction and carries a greater prognostic power. These results prompt future research assessing eAlb as a biomarker for predicting prognosis and treatment response.
Authors: Joan Clària; Rudolf E Stauber; Minneke J Coenraad; Richard Moreau; Rajiv Jalan; Marco Pavesi; Àlex Amorós; Esther Titos; José Alcaraz-Quiles; Karl Oettl; Manuel Morales-Ruiz; Paolo Angeli; Marco Domenicali; Carlo Alessandria; Alexander Gerbes; Julia Wendon; Frederik Nevens; Jonel Trebicka; Wim Laleman; Faouzi Saliba; Tania M Welzel; Agustin Albillos; Thierry Gustot; Daniel Benten; François Durand; Pere Ginès; Mauro Bernardi; Vicente Arroyo Journal: Hepatology Date: 2016-08-25 Impact factor: 17.425
Authors: José Alcaraz-Quiles; Mireia Casulleras; Karl Oettl; Esther Titos; Roger Flores-Costa; Marta Duran-Güell; Cristina López-Vicario; Marco Pavesi; Rudolf E Stauber; Vicente Arroyo; Joan Clària Journal: Hepatology Date: 2018-10-13 Impact factor: 17.425
Authors: Karl Oettl; Vanessa Stadlbauer; Franz Petter; Joachim Greilberger; Csilla Putz-Bankuti; Seth Hallström; Carolin Lackner; Rudolf E Stauber Journal: Biochim Biophys Acta Date: 2008-05-01
Authors: Jonel Trebicka; Javier Fernandez; Maria Papp; Paolo Caraceni; Wim Laleman; Carmine Gambino; Ilaria Giovo; Frank Erhard Uschner; Cesar Jimenez; Rajeshwar Mookerjee; Thierry Gustot; Agustin Albillos; Rafael Bañares; Martin Janicko; Christian Steib; Thomas Reiberger; Juan Acevedo; Pietro Gatti; William Bernal; Stefan Zeuzem; Alexander Zipprich; Salvatore Piano; Thomas Berg; Tony Bruns; Flemming Bendtsen; Minneke Coenraad; Manuela Merli; Rudolf Stauber; Heinz Zoller; José Presa Ramos; Cristina Solè; Germán Soriano; Andrea de Gottardi; Henning Gronbaek; Faouzi Saliba; Christian Trautwein; Osman Cavit Özdogan; Sven Francque; Stephen Ryder; Pierre Nahon; Manuel Romero-Gomez; Hans Van Vlierberghe; Claire Francoz; Michael Manns; Elisabet Garcia; Manuel Tufoni; Alex Amoros; Marco Pavesi; Cristina Sanchez; Anna Curto; Carla Pitarch; Antonella Putignano; Esau Moreno; Debbie Shawcross; Ferran Aguilar; Joan Clària; Paola Ponzo; Christian Jansen; Zsuzsanna Vitalis; Giacomo Zaccherini; Boglarka Balogh; Victor Vargas; Sara Montagnese; Carlo Alessandria; Mauro Bernardi; Pere Ginès; Rajiv Jalan; Richard Moreau; Paolo Angeli; Vicente Arroyo Journal: J Hepatol Date: 2020-07-13 Impact factor: 25.083
Authors: Mauro Bernardi; Paolo Angeli; Joan Claria; Richard Moreau; Pere Gines; Rajiv Jalan; Paolo Caraceni; Javier Fernandez; Alexander L Gerbes; Alastair J O'Brien; Jonel Trebicka; Thierry Thevenot; Vicente Arroyo Journal: Gut Date: 2020-02-26 Impact factor: 23.059
Authors: V Mazzaferro; E Regalia; R Doci; S Andreola; A Pulvirenti; F Bozzetti; F Montalto; M Ammatuna; A Morabito; L Gennari Journal: N Engl J Med Date: 1996-03-14 Impact factor: 176.079