Determination of Effective Albumin in Patients With Decompensated Cirrhosis: Clinical and Prognostic Implications.
Determination of Effective Albumin in Patients With Decompensated Cirrhosis: Clinical and Prognostic Implications.
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DOI：
10.1002/hep.31798
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发表时间：
2021-10
期刊：
影响因子：
--
通讯作者：
Caraceni P
中科院分区：
文献类型：
--
作者：
Baldassarre M;Naldi M;Zaccherini G;Bartoletti M;Antognoli A;Laggetta M;Gagliardi M;Tufoni M;Domenicali M;Waterstradt K;Paterini P;Baldan A;Leoni S;Bartolini M;Viale P;Trevisani F;Bernardi M;Caraceni P
肝硬化循环白蛋白可能因为累积的结构损伤而功能失调，这就产生了有效白蛋白浓度（eAlb）的概念，指的是结构和功能完整的白蛋白部分。我们的目的是评估失代偿性肝硬化患者的eAlb，并分析其与白蛋白功能和临床结果的关系，并与总白蛋白浓度（tAlb）进行比较。我们评估了319例伴有或不伴有急性慢性肝功能衰竭（ACLF）的肝硬化急性失代偿（AD）住院患者和18例年龄和性别相当的代偿性肝硬化门诊患者。tAlb采用标准方法定量，eAlb采用液相色谱/电喷雾电离/质谱法和标准方法定量。通过电子顺磁共振分析评价白蛋白结合和解毒效率。失代偿肝硬化患者的循环白蛋白表现出多种结构异常，可逆氧化和糖化是最常见的。结果，随着肝硬化的恶化，eAlb逐渐下降，在代偿性肝硬化、AD和ACLF患者之间以及有无并发症的患者中，eAlb优于tAlb。此外，与ACLF的结合能力密切相关的是eAlb，而不是tAlb。入院时eAlb预测30天内ACLF发生及90天死亡率优于tAlb。这项大型观察性研究为失代偿性肝硬化患者提供了证据，证明eAlb可以量化并与临床常规测量的tAlb区分开来。与tAlb相比，eAlb与疾病严重程度和白蛋白功能障碍更密切相关，具有更大的预后能力。这些结果促使未来的研究评估eAlb作为预测预后和治疗反应的生物标志物。
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). 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. 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.
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影响因子：
1.7
作者：
Plantier, Jean-Luc;Duretz, Veronique;Jorieux, Sylvie
通讯作者：
Jorieux, Sylvie
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2
作者：
Kleinova, M;Belgacem, O;Allmaier, G
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Allmaier, G
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Piccoli, Pierluigi
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作者：
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影响因子：
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Arroyo, Vicente