Therapeutic innovation

Influence of gender on albumin response in samples from the ATTIRE cohort

The issue

Acute decompensation (AD) and acute-on-chronic Liver failure (ACLF) are characterised by increased systemic inflammation and immunosuppression. There are data supporting gender differences in the inflammatory response in health and differences in outcomes between genders in AD/ACLF. Post-hoc subgroup analyses of the neutral ATTIRE trial – Albumin to prevent infection in chronic liver failure – suggested a differential effect of targeted albumin infusions according to gender and so we are investigating this in greater detail.

The approach

Investigating data from the ATTIRE trial significantly higher interleukin-8 (IL-8) levels in women were found irrespective of treatment group, suggesting a difference in the inflammatory response, although infection rates and overall outcomes were similar and targeted albumin had no discernible effect on IL-8, one of the major mediators of the inflammatory response. The improved renal function in albumin-treated women without evidence of increased adverse events may relate to their increased rate of serum albumin increment. Plasma sample analyses from the targeted albumin patients suggest a reduction in plasma renin activity and an improvement in albumin function in females but not males. Together, these findings warrant further investigation.

The improved renal function in albumin-treated women may relate to their increased rate of serum albumin increment. Decreased renal dysfunction is further supported by a decrease in renin seen in women receiving albumin transfusion. Furthermore, targeted albumin infusions in women did not result in increased risk of oedema unlike men. These data suggest sex differences in response to fluid resuscitation, that we will investigate further.