Albumin dialysis improves hepatic encephalopathy and decreases circulating phenolic aromatic amino acids in patients with alcoholic hepatitis and severe liver failure.
Crit Care. 2009 Jan 28;13(1):R8
Authors: Pares A, Deulofeu R, Cisneros L, Escorsell A, Salmeron JM, Caballeria J, Mas A
ABSTRACT: INTRODUCTION: The aim of the study was to assess the effects of albumin dialysis on hepatic encephalopathy and circulating levels of amino acids in severe alcoholic hepatitis. METHODS: The study was carried out on nine patients with severe alcoholic hepatitis and four with primary biliary cirrhosis treated with the molecular adsorbent recirculating system. Besides standard liver function tests, circulating levels of ammonia, total, branched chain and aromatic amino acids and the presence and severity of hepatic encephalopathy and number connection test were measured before and after each treatment. RESULTS: There were 8 episodes of encephalopathy in patients with alcoholic hepatitis. Albumin dialysis was associated with significant improvement in encephalopathy (p=0.02), and a decrease in total amino acid levels (2490 +/- 152 to 2229 +/- 114 uM, p<0.001). Moreover, the Fischer's ratio, which was significantly lower in patients with alcoholic hepatitis (1.32 +/- 0.08) than in controls (3.20 +/- 0.16), increased by 17% after albumin dialysis (p<0.02) due to a significant decrease in phenolic aromatic amino acids (193 +/- 17 to 165 +/- 9 uM, p=0.04). No differences were observed in circulating ammonia. Changes in phenolic aromatic amino acids and the Fischer's ratio were more prominent in patients with encephalopathy and higher bilirubin removal. Albumin dialysis did not significantly affect the amino acid profile in controls. CONCLUSIONS: Albumin dialysis results in a significant decrease in circulating phenolic aromatic amino acids and improvement of hepatic encephalopathy in patients with severe liver failure.
PMID: 19175915 [PubMed - as supplied by publisher]