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Attire randomised clinical trial
Craig Miller
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Blog Websites, Websites, Articles & Advanced Hepatology, UK
Correspondence: Craig Miller, Blog Websites, Websites, Articles & Advanced Hepatology, Tel 7903 537288
Received: November 24, 2015 | Published: December 7, 2015
Citation: Miller C. Attire randomised clinical trial. J Liver Res Disord Ther. 2015;1(2):50. DOI: 10.15406/jlrdt.2015.01.00010
Scientific theory behind ATTIRE
Liver disease is a major challenge facing the NHS with bacterial infection the most serious cause of morbidity and mortality in patients with advanced liver disease.
A defective innate immune response was first observed in cirrhosis 30years ago and is considered to underlie the predisposition to, and poor outcome from, infection. There is however no medical strategy to restore immune competence in these patients.
Elevated circulating Prostaglandin E2 (PGE2) levels have been shown to contribute to immune suppression in liver cirrhosis. PGE2 is more bio-available and, consequently, more immune suppressive because of decreased serum albumin levels, as albumin binds and catalyses inactivation of PGE2. Albumin is synthesized exclusively in the liver and levels fall as the synthetic function of the liver declines with worsening cirrhosis. The functional binding capacity of albumin is also known to be dysfunctional in liver cirrhosis.
Albumin could thus be repurposed as an effective immune restorative drug in patients with decompensated liver cirrhosis. We aim to evaluate treatment with 20% HAS to see if raising and maintaining serum albumin levels at near normal will result in fewer nosocomial infections in these patients and less sepsis-related organ failure, reduced length of stay and lower mortality.
Treatment phase
Albumin is to be administered via IV for a period of 14days at a certain dose, follow up is discharge and maintaining absent from alcohol, fresh healthy balanced diet, and a significant reduce in any smoking. I also strongly advise that motivational and confidence building programmes be integrated into the treatment phase to secure a better recovery.
Acknowledgements
None.
Conflict of interest
Author declares that there is no conflict of interest.
©2015 Miller. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.