The Role of Correcting Structural and Functional Albumin Properties in Ascites Control in Decompensated Cirrhotic Patients

Abstract

Аim: to study the structural and functional characteristics of albumin in patients with decompensated cirrhosis, their relationship with ascites; to identify the relationship between improvement in albumin characteristics and regression of ascites.Materials and methods. Fifty patients with decompensated liver cirrhosis and ascites were divided into groups. The first group received standard treatment for cirrhosis, the second — standard treatment and replacement therapy with 20 % human albumin solution at a dose of 200 mL per week for 3 months.Results. The value of the native conformation of albumin and the functional parameters of albumin were significantly lower than in the group of healthy individuals (p < 0.001). With the severity of ascites, the native conformation index (DR), which characterizes the structural usefulness of the albumin molecule, decreased. Median DR for ascites stage I (IAC) was –1.69, II grade — –2.28, III grade — –2.42 (p < 0.05). Replacement therapy with albumin allowed to achieve regression of ascites in 48.4 % of patients, compared with 7.1 % in the standard treatment group. Along with clinical improvement, restoration of albumin structural and functional properties was observed in the albumin group. The mean serum albumin level at which ascites remained in remission for 3 months was 42.11 g/L (p < 0.001).Conclusions and discussion. The structural and functional characteristics of albumin were impaired in patients with decompensated cirrhosis and ascites. The severity of changes in the structural and functional properties of albumin depended on the severity of ascites. The regression of ascites was accompanied by the restoration of the functional and structural usefulness of albumin against the backdrop of albumin replacement therapy. The criterion for stopping transfusion therapy with albumin can be the achievement of a serum albumin level of 42.11 ± 7.04 g/L, DR — 1.05, BE — 73.51 %, RTQ — 75.10 %, DTE — 72.71 %.