Albumin Concentration In Patients Research Articles

CURRENT PROBLEMS OF THE DIAGNOSTICS AND TREATMENT OF PURULENT-INFLAMMATORY DISEASES AND SEPSIS

A deep understanding of the pathogenesis is the key point in the formation of diagnostic strategies and treatment tactics for patients with various diseases. In this paper, the thorough analysis of the microscopic processes that occur in the bodies of patients with purulent-septic diseases was carried out. The pathogenetic concept of the diagnostic and treatment model of purulent-inflammatory diseases and sepsis was proposed and presented. It is based on the fact that in diseases accompanied by endogenous intoxication, part of the albumin molecules in the blood of patients are blocked by toxins. However, the presence of albumin in the blood does not always reflect the completeness of its transport function. Its binding centers can be blocked by toxic ligands, due to which the transport capacity is sharply reduced. As a result, there are two types of albumin molecules in the blood: normal (concentration: X) and blocked by toxins /pathological (concentration: 1-X). So, pathological albumin molecules lose the ability to perform their basic functions, namely transport and detoxification. This allows us to assume that the presence of albumin and its functional state can influence the course of burn disease and the development of sepsis. The proposed diagnosis of sepsis consists in definition of Х*, i.e. the maximum minimum value of the concentration of albumin in patients with sepsis. If Х is more than Х*, this ensures the viability of the organism to some extent. Modern complex diagnostics, including early, within the framework of the method of fluorescence spectroscopy and biomarkers of purulent-septic diseases, and effective methods of their treatment and modern effective control of the treatment process are proposed.

Effects of omega-3 supplementation on serum albumin, pre-albumin and the CRP/albumin ratio in hospitalized patients: a systematic review and meta-analysis.

Low serum albumin and pre-albumin concentrations are associated with edema, infection, thrombosis, heart failure, and mortality. This comprehensive systematic review and meta-analysis of clinical trials was conducted to summarize the available findings on the impact of omega-3 supplementation on albumin, pre-albumin, and the C-reactive protein/albumin ratio in hospitalized patients. PubMed, Web of Science, Scopus, and Google Scholar databases were searched from January 1990 to October 2021. Extracted data from 50 randomized controlled trials (RCTs) with a total number of 3196 participants were analyzed using the random-effects model. The dose-dependent effect was also evaluated. Oral omega-3 supplementation significantly increased serum albumin concentrations in patients with cancer (weighted mean difference [WMD]: 0.19; 95% CI: 0.05, 0.33, P= 0.006), patients on dialysis (WMD: 0.14; 95% CI: 0.01, 0.28, P= 0.042), and those with hypoalbuminemia (WMD: 0.38; 95% CI: 0.03, 0.72, P = 0.033); however, there was no significant effect among patients with gastrointestinal or hepatologic diseases. Moreover, each 1000 mg/day increase in oral omega-3 supplementation resulted in elevated serum albumin levels in cancer patients (WMD: 0.15; 95% CI: 0.07, 0.24, P < 0.001). In addition, a favorable effect of oral omega-3 supplementation on pre-albumin levels was observed among patients with cancer (WMD: 33.87; 95% CI: 12.34, 55.39, P = 0.002). A similar significant effect of parenteral omega-3 supplementation on pre-albumin concentrations was seen among those with gastrointestinal and hepatologic diseases as well (WMD: 23.30; 95% CI: 13.58, 33.03, P < 0.001). No significant effect of oral omega-3 supplementation on the CRP/albumin ratio was found. Overall, omega-3 fatty acids supplementation resulted in a favorable change in serum albumin and pre-albumin concentrations in hospitalized patients. PROSPERO registration no. CRD42021285704.

121 - Gross tumour volume predicts survival and correlates with pre-treatment serum albumin concentration in patients with stage III non-small cell lung cancer treated with chemo-radiotherapy

121 - Gross tumour volume predicts survival and correlates with pre-treatment serum albumin concentration in patients with stage III non-small cell lung cancer treated with chemo-radiotherapy

Decline in serum albumin concentration is a predictor of serious events in nonalcoholic fatty liver disease.

Nonalcoholic fatty liver disease (NAFLD) is associated with metabolic syndrome, which includes diabetes mellitus and hyperlipidemia. A fraction of NAFLD patients develop nonalcoholic steatohepatitis, leading to cirrhosis associated with various serious complications, including hepatocellular carcinoma, gastroesophageal varices, cardiovascular events, and other organ malignancy. Although the incidence of chronic viral hepatitis with associated complications has gradually decreased as highly effective antiviral therapies have been established, the number of patients with steatohepatitis has been increasing.This retrospective study examined data of 229 patients from 22 hospitals in our region. We examined 155 cases of chronological data and assessed the development of liver fibrosis and evaluated hepatic reserve-related markers such as platelet count, FIB-4 index, prothrombin time, and serum albumin concentration. We analyzed the relationship of these chronological changes and the incidence of NAFLD related serious complications.Data related to liver fibrosis progression, albumin, and prothrombin time were significantly associated with the occurrence of serious complications associated with cirrhosis. We compared 22 event and 133 nonevent cases of chronological changes in the data per year and found that serum albumin concentration was significantly lower in the group that developed serious complications (event cases: -0.21 g/dL/year, nonevent cases: –0.04 g/dL/year (P < .001)). This albumin decline was only the associated factor with the event incidence by multivariate analysis (P < .01).Annual decline in serum albumin concentration in patients with NAFLD is associated with serious events from the outcome of multicenter retrospective study. This highlights its potential utility as a surrogate marker to assess the efficacy of prediction of NAFLD related serious events.

Combining and converting groups when extracting data for meta-analysis

It is important that as much evidence as possible is included in the pooled analyses of systematic reviews. Therefore, systematic reviewers may want to analyse outcomes that are not completely...

The Effect of Acidosis on Albumin Level in Patients Treated With Regular Hemodialysis (Single Center Study)

BACKGROUND: Hypoalbuminemia is the most powerful predictor of mortality in end-stage renal disease on hemodialysis. Metabolic acidosis induces net negative nitrogen and total body protein balance. Some patients undergoing maintenance dialysis have low plasma bicarbonate levels due to inadequate dialysis. We aimed to evaluate the role of metabolic acidosis on serum albumin concentration in patients with end stage renal disease on hemodialysis, and to determine differences of serum bicarbonate level before and after hemodialysis in actual situation. &#x0D; &#x0D; METHODS: This cross sectional comparative study was conducted in the Iraqi Center for Hemodialysis/ Baghdad Teaching Hospital from June to December 2015. It included 100 subjects with end stage renal disease on hemodialysis. They were divided equally into cases with low albumin and comparison group with normal albumin level. Serum bicarbonate and the Kt/V were measured for all subjects before, after, and before next hemodialysis session to show the adequacy of dialysis.&#x0D; &#x0D; RESULTS: There was a significant association between low bicarbonate and low albumin level in hemodialysis patient and between numbers and duration of dialysis session with albumin. Low Kt/V was significantly associated with hypoalbuminemia. There was no statistically significant association between age and gender with hypoalbuminemia.&#x0D; &#x0D; CONCLUSION: This study shows that patients with metabolic acidosis had a lower serum albumin concentration and there was a significant correlation between numbers, duration and adequacy of hemodialysis sessions and albumin level. We recommend to increase the numbers of dialysis centers in Iraq and adjust the bicarbonate doses in dialysate according to patient&amp;rsquo;s bicarbonate levels.

Serum albumin concentration as an independent prognostic indicator in patients with pulmonary arterial hypertension.

Serum albumin is a strong prognostic indicator for many disease processes, yet limited data exist regarding its prognostic relationship in pulmonary arterial hypertension (PAH). Our study aims to assess the relationship of hypoalbuminemia with disease severity and mortality in this population. Serum albumin concentrations are a predictor of outcomes in PAH. A retrospective review of all patients with World Health Organization group 1 PAH evaluated between March 2001 and August 2008 was performed. Patients were stratified into groups based on serum albumin concentration ≤3.3 g/dL (hypoalbuminemia) vs >3.3 g/dL. Clinical, hemodynamic, and survival comparisons were compared between groups using Student t test and χ2 test, followed by univariate analysis and multivariate logistic regression. A total of 163/273 (59.7%) patients had a documented serum albumin concentration. Hypoalbuminemia was present in 41 (25.2%) patients and serum albumin ≤3.3 g/dL represented the lowest quartile of serum albumin. Patients with hypoalbuminemia had higher rates of renal dysfunction (26.8% vs 9.8%, P =0.0069) and hepatic dysfunction (29.3% vs 6.6%, P <0.001), and lower hemoglobin levels (11.6 vs 13.4 g/dL, P < 0.001). Hemodynamic and functional capacity assessments were comparable between groups. Independent predictors of mortality included low albumin levels (hazard ratio [HR]: 0.485, P = 0.008), high right atrial systolic area (HR: 1.062, P = 0.003), low Fick-derived cardiac index (HR: 1.465, P = 0.016), and high New York Heart Association functional class (HR: 1.767, P = 0.042). Patients with hypoalbuminemia demonstrated a significantly lower survival rate at latest follow-up (P = 0.01). Lower serum albumin concentrations in patients with PAH are associated with higher mortality and can serve as a marker of disease severity in this patient population.

Adropin and irisin levels in relation to nutrition, body composition, and insulin resistance in patients with end-stage renal disease on chronic hemodialysis and peritoneal dialysis.

INTRODUCTION Newly discovered myokines, adropin, and irisin, are regulators of energy homeostasis and metabolism in humans. In end-stage renal disease (ESRD), the significance and role of irisin and adropin as metabolism regulators are still unclear. OBJECTIVES The aim of this study was to evaluate serum adropin and irisin levels and establish their relation to insulin resistance, nutritional status, and hydration status in patients on chronic hemodialysis (HD) and on peritoneal dialysis (PD). PATIENTS AND METHODS The study consisted of 71 subjects, including 48 patients (18 women, 30 men; median age, 56.5 years; range, 26-84 years) either on HD (n = 41) or PD (n = 7) and 36 healthy controls matched for age and sex. We measured the serum levels of adropin, irisin, creatinine, albumin, glucose, and insulin, as well as the plasma levels of lipids. The bioimpedance method was used to evaluate the body composition and overhydration in patients with ESRD. RESULTS Irisin levels were significantly lower in patients with ESRD compared with controls, but there were no differences in adropin levels between both study groups. Adropin levels were inversely correlated with body mass, lean tissue mass, total, intracellular, and extracellular water, and albumin concentrations in patients with ESRD. Irisin levels were positively correlated with glucose levels and homeostasis model assessment of insulin resistance. No significant correlations were observed between adropin and irisin concentrations and overhydration. CONCLUSIONS Adropin may be considered as a new marker of nutritional status in patients with ESRD. The significance and cause of low irisin levels characteristic for these patients are still unclear. Adropin and irisin should be further investigated as possible markers of cachexia and insulin resistance in patients with ESRD.

Resultado de la intervención Enseñanza: Dieta prescrita en la consulta de enfermedad renal crónica avanzada

En la consulta de enfermedad renal crónica avanzada (ERCA), se proporcionan cuidados a los pacientes con enfermedad renal crónica con un filtrado glomerular (FG) &lt; 30 ml/min. Estos incluyen diferentes intervenciones de enfermería. Una de ellas es la intervención 5614 Enseñanza: dieta prescrita. Objetivo: Analizar la eficacia de la intervención 5614 Enseñanza: dieta prescrita, en pacientes ERCA realizada en la consulta de enfermería, en la primera visita. Material y métodos: Estudio cuasiexperimental. Se incluyeron 92 pacientes incidentes en la consulta ERCA en 2014. Se realizó la intervención 5614 Enseñanza: dieta prescrita y se evaluaron indicadores de resultado 1004 Estado nutricional a los 2 meses de la intervención. Se llevó a cabo una estadística descriptiva de las variables pre y post intervención. Resultados: Edad media 69,5±15 años, 64,1% (n=59) hombres, 35,9% (n=33) mujeres, 41,3% diabéticos. Después de la intervención el 62% de los pacientes disminuyeron el valor del K, el 54,3% el del P, el 55,4% el del colesterol total, el 59,8% el del colesterol-LDL, y el 44,6% el del ácido úrico. El 67,4% de los pacientes presentó pérdida ponderal. En estos pacientes la variación media de la albúmina fue -0,005±0,0028 mg/dL. El FG permaneció estable en el 63% de los pacientes. La PAS media disminuye en el 42,4% de los pacientes y la PAD media en el 38%. Conclusiones: Tras la intervención 5614 Enseñanza: dieta prescrita realizada a los pacientes ERCA en la primera visita, se observa disminución del peso y valores plasmáticos de P, K, colesterol- LDL, colesterol total y ácido úrico. La Función renal permanece estable. La concentración de albúmina en los pacientes que perdieron peso se mantiene estable. La diferencia de la media para los valores de K y colesterol total fue estadísticamente significativa.

Serum albumin perturbations in cyanotics after cardiac surgery: Patterns and predictions.

Introduction:Hypoalbuminemia is a well-recognized predictor of general surgical risk and frequently occurs in patients with cyanotic congenital heart disease (CCHD). Moreover, cardiopulmonary bypass (CPB)-induced an inflammatory response, and the overall surgical stress can effect albumin concentration greatly. The objective of his study was to track CPB-induced changes in albumin concentration in patients with CCHD and to determine the effect of hypoalbuminemia on postoperative outcomes.Materials and Methods:Prospective observational study conducted in 150 patients, Group 1 ≤18 years (n = 75) and Group 2 >18 years (n = 75) of age. Albumin levels were measured preoperatively (T1), after termination of CPB (T2) and 48 h post-CPB (T3). Primary parameters (mortality, duration of postoperative ventilation, duration of inotropes and duration of Intensive Care Unit [ICU] stay) and secondary parameters (urine output, oliguria, arrhythmias, and hemodynamic parameters) were recorded.Results:The albumin levels in Group 1 at T1, T2, and T3 were 3.8 ± 0.48, 3.2 ± 0.45 and 2.6 ± 0.71 mg/dL; and in Group 2 were 3.7 ± 0.50, 3.2 ± 0.49 and 2.7 ± 0.62 mg/dL respectively. All patients showed a significant decrease in albumin concentration 48 h after surgery (P < 0.01). Analysis between the groups, however, showed no statistical difference. Eleven patients expired during the study period, and nonsurvivors showed significantly lower serum albumin concentration 48 h after surgery 2.3 ± 0.62 mg/dL versus 3.7 ± 0.56 mg/dL in the survivors (P < 0.05). Receiver operating characteristic curve showed that a baseline albumin cut-off value of 3.3 g/dL predicts mortality with a positive predictive value 47.6% and a negative predictive value of 99.2% (P < 0.05). A strong correlation was seen between albumin levels at 48 h with duration of CPB (r2 = 0.6321), ICU stay (r2 = 0.7447) and incidence of oliguria (r2 = 0.8803).Conclusions:The study demonstrated similar fall in albumin concentration in cyanotic patients (both adult and pediatric) in response to CPB. Low preoperative serum albumin concentrations (<3.3 g/dL) can be used to identify and prognosticate subset of cyanotics predisposed to additional surgical risk.

Relationship Between Serum Albumin Concentration and Periodontal Condition in Patients With Head and Neck Cancer

Serum albumin concentration is known to be an independent predictor of survival in head and neck cancer. The previous studies suggested relationships between serum albumin concentration and oral health status in populations without serious systemic disorders. However, these relationships remain unclear in patients with head and neck cancer. The purpose of this study is to investigate the relationship between serum albumin concentration and oral health status in patients with head and neck cancer. Fifty individuals diagnosed with primary head and neck cancer, 25 individuals with normal serum albumin concentration (≥3.85 g/dL), and 25 age- and sex-matched individuals with lower serum albumin concentration (<3.85 g/dL) were analyzed. General status, including cancer stage, body mass index, drinking and smoking habits, and biochemical serum markers, were evaluated. Oral health status, including periodontal condition and occlusion tooth pairs, were also evaluated. Mean clinical attachment level (CAL) and C-reactive protein in the lower serum albumin concentration group were greater than those in the normal serum albumin concentration group (P = 0.009 and P = 0.002, respectively). However, there were no significant differences in any other oral and/or serum parameters between the two serum albumin groups. A logistic regression model showed that mean CAL was significantly associated with high or low levels of serum albumin concentration (odds ratio = 9.752; 95% confidence interval = 1.702 to 55.861; P = 0.011). This study suggests an association between periodontal disease and serum albumin concentration in patients with head and neck cancer. Longitudinal studies are necessary to examine the causal relationship between serum albumin concentration and periodontal condition.

Clinical Significance of the Augmentation Index in Patients with Preserved Kidney Function

The augmentation index (AIx) indicates arterial wave reflection. Clinical studies have shown a relationship between an elevated AIx and cardiovascular disease. This cross-sectional study attempted to clarify the clinical significance of AIx in patients with preserved kidney function. The subjects were 321 patients with preserved kidney function (an estimated glomerular filtration rate ≥60 mL/min/1.73 m2 and normoalbuminuria) but with no history of cardiovascular events. The AIx was determined in the radial artery by means of tonometry, and the relationships of the AIx to kidney function and markers of atherosclerosis were examined. A significant positive correlation (r=0.30; p<0.001) was found between the AIx and the urinary albumin concentration. The AIx showed a significant positive correlation (r=0.28; p<0.001) with the serum high-sensitivity C-reactive protein concentration, as a marker of inflammation; with the urinary 8-iso-prostaglandin F2α concentration (r=0.31; p<0.001), as a marker of oxidative stress; and with the cardio-ankle vascular index (r=0.17; p<0.01), as a marker of systemic arterial stiffness. Multiple regression analysis indicated that the urinary 8-iso-prostaglandin F2α concentration (t=5.1; p<0.001), serum high-sensitivity C-reactive protein concentration (t=4.9; p<0.001), and urinary albumin concentration (t=3.6; p<0.01) were independent variables for AIx after adjustment. These findings indicate that the AIx reflects inflammation, oxidative stress, and the urinary albumin concentration in patients with preserved kidney function.

Early administration of branched-chain amino acid granules

The effect of malnutrition on survival in patients with decompensated liver cirrhosis has not been well defined. Nutritional intervention with branched-chain amino acid (BCAA) can increase serum albumin concentration in patients with decompensated cirrhosis but its effects on survival are unclear. The BCAA to tyrosine ratio (BTR) is a surrogate marker (the normal range of BTR is between 4.41 and 10.05, and a Fischer's ratio of 1.8 corresponds to a BTR of 3.5) in patients with decompensated liver cirrhosis, and BCAA inhibits hepatic carcinogenesis in patients with compensated cirrhosis. This review discusses data regarding the effect of early administration of BCAA granules based on the ratio of BCAA to BTR on prognosis in patients with cirrhosis.

Reduced Serum Albumin Concentration before Heart Transplantation Predicts Poor Post-Transplant Prognosis

Levels of serum albumin have been recognized as a marker of malnutrition, inflammation, impaired hepatic synthesis and overall catabolic status. We investigated the relationship between serum albumin concentration in patients with severe heart failure and their long-term outcome after cardiac transplantation.

Associations between Cerebrospinal Fluid Protein Concentrations, Serum Albumin Concentrations and Intracranial Pressure in Neurotrauma and Intracranial Haemorrhage

Recent evidence suggests that using intravenous isotonic albumin solution for haemodynamic resuscitation in neurotrauma is associated with adverse outcomes. This study assessed the correlations between cerebrospinal fluid protein concentrations, serum albumin concentrations and intracranial pressure in a cohort of neurosurgical patients. After obtaining ethics committee approval, correlations between concomitant cerebrospinal fluid protein concentrations, serum albumin concentrations and the mean daily intracranial pressure of 63 consecutive neurosurgical patients, grouped as neurotrauma or intracranial haemorrhage, admitted between 1 January and 31 December 2007, were assessed. The mean daily intracranial pressure was significantly associated with cerebrospinal fluid protein concentrations (Spearman correlation coefficient [SCC] = 0.496, P = 0.001), white cell counts (SCC = 0.359, P = 0.001), red cell counts (SCC = 0.399, P = .0O01) and serum albumin concentrations (SCC = 0.431, P = 0.001) in patients with neurotrauma (n=23). Cerebrospinal fluid protein concentrations were also significantly associated with concomitant serum albumin concentrations (SCC = 0.393, P = 0.001) in these patients. In patients with intracranial haemorrhage (n=40), the mean daily intracranial pressure was only significantly associated with cerebrospinal fluid white cell and red cell counts but not cerebrospinal fluid protein and serum albumin concentrations. In summary, intracranial pressure is correlated with cerebrospinal fluid protein and serum albumin concentrations in patients with severe neurotrauma, and these suggest that blood-brain barrier may not be completely intact after severe neurotrauma.

Comparison of Bromcresol Purple and Capillary Protein Electrophoresis for Quantification of Serum Albumin in Multiple Myeloma

According to the International Staging System (1), serum albumin concentration is a key factor in determining patient prognosis in multiple myeloma. A recent study published in Clinical Chemistry described significant discordance between bromcresol green (BCG)1 albumin dye and agarose gel serum protein electrophoresis (SPEP) for albumin concentration determination in patients with high concentrations of monoclonal (M)- protein (2). Also available, however, are commonly used alternative methods for albumin determination, such as bromcresol purple (BCP) albumin dye and capillary zone SPEP (3). To examine whether the previously observed comparative discordance of measured albumin concentration is limited only to the BCG dye and agarose gel SPEP methods of albumin determination (2), we retrospectively compared measured albumin concentrations as determined by BCP albumin dye and capillary zone SPEP in a large cohort of multiple myeloma patients. The ratio of measured BCP albumin to SPEP albumin concentrations in patients with a previously identified monoclonal protein was retrospectively calculated for 579 specimens submitted to the University of Arkansas Immunology laboratory for routine serum protein electrophoresis by capillary zone SPEP. All specimens had concurrent albumin determination by a BCP albumin dye method. These consisted of 355 IgG, 122 IgA, 29 IgM, 13 IgD, and 60 free-light-chain myeloma patient specimens. …

Mutations and polymorphisms of the gene of the major human blood protein, serum albumin

We have tabulated the 77 currently known mutations of the familiar human blood protein, serum albumin (ALB). A total of 65 mutations result in bisalbuminemia. Physiological and structural effects of these mutations are included where observed. Most of the changes are benign. The majority of them were detected upon clinical electrophoretic studies, as a result of a point mutation of a charged amino acid residue. Three were discovered by their strong binding of thyroxine or triiodothyronine. A total of 12 of the tabulated mutations result in analbuminemia, defined as a serum albumin concentration of <1 g/L. These were generally detected upon finding a low albumin concentration in patients with mild edema, and involve either splicing errors negating translation or premature stop codons producing truncated albumin molecules. A total of nine mutations, five of those with analbuminemia and four resulting in variants modified near the C-terminal end, cause frameshifts. Allotypes from three of the point mutations become N-glycosylated and one C-terminal frameshift mutation shows O-glycosylation.

Serum Prealbumin: Is It a Marker of Nutritional Status or of Risk of Malnutrition?

Hospitalized patients who are undernourished are more likely to develop clinical complications and have relatively poor outcomes, with increased length of stay (LOS) 1 and higher mortality compared with well-nourished patients. Provision of adequate nutritional support reduces the complication rate and improves outcome (1). Considerable efforts have therefore been made to identify patients at risk of malnutrition, with a view to early provision of nutritional support. A full nutritional assessment is a complex process, involving detailed assessment of nutritional intake, changes in body composition, signs or symptoms of nutritional deficiency or excess, and laboratory tests, and it should include not only protein-energy status but also vitamins and essential trace elements. Because of this complexity, rapid screening tests have been sought to identify patients who may already be malnourished or are at risk of malnutrition, who can then undergo a more detailed nutritional assessment. The screening tools with the most validation for protein-energy malnutrition include body mass index (weight/height2) in conjunction with recent changes in weight and a simple assessment of illness severity (2). In many patients, however, obtaining an accurate measurement of current and previous weight to allow calculation of rate of weight loss may not be possible, so clinicians have sought a rapid, reliable laboratory method, usually involving plasma proteins, to obtain comparable information. Serum albumin is of virtually no value in assessment or monitoring of nutritional status (3) but is mentioned here because, surprisingly, there still remain some clinicians who use it as part of their nutritional assessment. The main factor affecting plasma albumin concentration in patients is the rate of transcapillary escape into the interstitial fluid. This transcapillary escape of albumin is markedly increased in disease [as part of the systemic inflammatory response syndrome (SIRS)], leading to decreased plasma albumin concentrations (4). It is inevitable that …

Low-dose mecasermin [insulin-like growth factor-I (IGF-I)] increases albumin concentrations in patients with liver cirrhosis,

Low-dose mecasermin [insulin-like growth factor-I (IGF-I)] increases albumin concentrations in patients with liver cirrhosis,

Effects of Oral Branched-Chain Amino Acid Granules on Event-Free Survival in Patients With Liver Cirrhosis

Nutritional intervention with branched-chain amino acid (BCAA) is reported to increase serum albumin concentration in patients with decompensated cirrhosis. However, a definite conclusion on whether it can improve patients' survival has not yet been reached. The present study aimed to test possibilities of improving survival of patients with decompensated cirrhosis by using a BCAA preparation that is suitable for long-term oral administration. A multicenter, randomized, and nutrient intake-controlled trial on the comparative effects of BCAA orally administered at 12 g/day for 2 years versus diet therapy with defined daily food intake (1.0-1.4 g protein kg(-1) day(-1) including BCAA preparation and 25-35 kcal kg(-1) day(-1)) was conducted in 646 patients with decompensated cirrhosis. The primary end point was a composite of death by any cause, development of liver cancer, rupture of esophageal varices, or progress of hepatic failure (event-free survival). The secondary end points were serum albumin concentration and health-related quality of life (QOL) measured by Short Form-36 questionnaire. The incidence of events comprising the primary end point significantly decreased in the BCAA group as compared with the diet group (hazard ratio, 0.67; 95% confidence interval, 0.49-0.93; P = .015; median observation period, 445 days). Serum albumin concentration increased significantly in the BCAA group as compared with the diet group (P = .018). The "general health perception" domain in Short Form-36 measures was also improved (P = .003). Patients' adherence to the prescription was favorable. Oral supplementation with a BCAA preparation that can be administered for a long period improves event-free survival, serum albumin concentration, and QOL in patients with decompensated cirrhosis with an adequate daily food intake.