Doctors use protein in blood to help liver patients fight infection

Patel, Dr Janisha (hepatology) photoResearchers in Southampton are using a protein found in the blood to help improve the effectiveness of antibiotics in patients with liver disease.

Patients with end-stage liver disease – known as decompensated cirrhosis – cannot produce albumin, which binds calcium, hormones, vitamins and drugs through the bloodstream.

Levels of the hormone prostaglandin E2 are high in this group of patients, leaving their immune systems compromised and prone to potentially life-threatening infections.

By administering the protein, which is given via injection, doctors at Southampton General Hospital and 26 other centres across the UK hope to bring patients’ albumin levels close to those of a healthy person which will inactivate the hormone and boost their immune systems.

More than 600,000 people in England and Wales have some form of liver disease and 60,000 of those have cirrhosis – scarring caused by long-term damage.

It is the fifth largest cause of death in the UK and the third most common cause of death among people between the ages of 35 and 65 years. Liver disease occurs most commonly as a result of alcohol misuse, hepatitis B and C infection and non-alcoholic fatty liver disease (NAFLD) caused by obesity.

As the condition can go undetected until the liver is severely damaged, more than three-quarters of patients arrive at emergency departments having never seen a liver specialist and one in four admitted with liver failure will not survive to one year following an admission to hospital.

“It is vital patients with cirrhosis are assessed for infections and treated with antibiotics to prevent potentially serious complications,” explained Dr Janisha Patel, a consultant hepatologist at University Hospital Southampton NHS Foundation Trust.

“However, their immune systems are compromised which enhances the aggressiveness of infections.

“So by boosting the albumin to bring it close to the same levels as a healthy person, we can help restore their immune systems and boost the power of antibiotics they are given.”

Dr Patel said the approach could not only improve patients’ recovery in hospital but may improve their survival after discharge.

“Through this trial we aim to give patients albumin to study their recovery from the time they are admitted to hospital and up to six months after, which will allow us to understand the longer-term benefit to them,” she said.

“Patients who go on to make positive changes to their lifestyle, such as giving up alcohol and better controlling their diabetes, have an 80% chance of survival over two years, so this intervention has the potential to make a significant impact during their acute illness.”

Posted on Thursday 12 April 2018