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Ischaemia‐modified albumin: a marker of bacterial infection in hospitalized patients with cirrhosis
Author(s) -
Gian Ferdinando A.,
Domenicali Marco,
Baldassarre Maurizio,
Bartoletti Michele,
Naldi Marina,
Laggetta Maristella,
Bertucci Carlo,
Colecchia Antonio,
Viale Pierluigi,
Bernardi Mauro,
Caraceni Paolo
Publication year - 2015
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12860
Subject(s) - cirrhosis , medicine , spontaneous bacterial peritonitis , albumin , hepatic encephalopathy , ascites , gastroenterology , serum albumin , liver disease , immunology
Background & Aims Patients with cirrhosis present structural changes of human serum albumin ( HSA ) affecting non‐oncotic functions. Ischaemia‐modified albumin ( IMA ), which reflects the capacity to bind cobalt, has been associated to patient mortality during acute‐on‐chronic liver failure. This study aimed to assess whether circulating IMA is elevated in advanced cirrhosis and its relationship with severity of cirrhosis and specific complications. Methods A total of 127 cirrhotic patients hospitalized for an acute complication of the disease and 44 healthy controls were enrolled. Plasma IMA and IMA to albumin ratio ( IMA r) were measured with a cobalt‐binding assay . HSA isoforms carrying post‐transcriptional molecular changes were assessed with HPLC ‐ ESI ‐ MS . The effect of endotoxemia on IMA was evaluated in rats with CC l 4 ‐cirrhosis. Results IMA / IMA r is significantly higher in cirrhotic patients than in controls, but no correlations were found with prognostic scores. IMA did not correlate with the altered HSA isoforms. Ascites, renal impairment and hepatic encephalopathy did not influence IMA / IMA r levels. In contrast, IMA / IMA r is significantly higher in infected than non‐infected patients. ROC curves showed that IMA / IMA r had similar discriminating performances for bacterial infection as C ‐reactive protein ( CRP ). Moreover, CRP and IMA were independently associated with bacterial infection. Consistently, endotoxin injection significantly increased IMA in cirrhotic, but not in healthy rats. Conclusions IMA is elevated in patients with advanced cirrhosis. The IMA level does not correlate with disease severity scores, but it is specifically associated to bacterial infection, showing a discriminating performance similar to CRP . Further investigations to assess IMA as a novel diagnostic test for bacterial infection are advocated.