Albumin and fibrinogen synthesis rates in advanced chronic liver disease

Serum albumin level is associated with mortality and hospital stays: A real-world data analysis

BACKGROUND & AIMS

The value of serum albumin might be underestimated, especially in cancer patients. We thus aimed to evaluate the association between serum albumin level at hospital admission and clinical outcomes in hospitalized patients with cancer.

METHODS

This is a retrospective, cross-sectional, and real-world data analysis. Hospitalized adult patients with malignant cancer were recruited from two tertiary hospitals. Serum level of albumin, which was measured within 24 h after hospital admission, was the exposure. Length of hospital stays (LOS) was the primary and all-cause in-hospital mortality was the secondary outcomes. Other information, including age, sex, types of cancer, history of hypertension and diabetes, surgery, blood routine test, liver and renal function, and dietary intake, were also abstracted from medical records.

RESULTS

A total number of 5187 adult patients with cancer (2949 were men and 2238 women; average age 61.6 ± 12.4 years and average albumin 40.3 ± 5.2 g/L) were included. The prevalence of hypoalbuminemia was 12.2 % (634/5187). Older patients, patients with liver injury, anemia, and with high level of WBC were positively, while those with overweight and high level of total triglycerides, were negatively associated with hypoalbuminemia. After adjustment of covariates, hypoalbuminemia was significantly associated with longer LOS in the current study. The increase of 5 g/L in serum level of albumin could result in 1.09 days (95%CI: -1.38, -0.80 days) shorter in LOS. The increase of 5 g/L in serum level of albumin was also associated with 45 % lower in risk of mortality (OR = 0.55; 95 % CI: 0.43, 0.7) after fully adjustment.

CONCLUSIONS

Serum albumin level at admission was associated with both LOS and mortality in patients with malignant cancer.

Methionine deficiency inhibited pyroptosis in primary hepatocytes of grass carp (Ctenopharyngodon idella): possibly via activating the ROS-AMPK-autophagy axis

BACKGROUND

Methionine (Met) is the only sulfur-containing amino acid among animal essential amino acids, and methionine deficiency (MD) causes tissue damage and cell death in animals. The common modes of cell death include apoptosis, autophagy, pyroptosis, necroptosis. However, the studies about the major modes of cell death caused by MD have not been reported, which worth further study.

METHODS

Primary hepatocytes from grass carp were isolated and treated with different doses of Met (0, 0.5, 1, 1.5, 2, 2.5 mmol/L) to examine the expression of apoptosis, pyroptosis, autophagy and necroptosis-related proteins. Based on this, we subsequently modeled pyroptosis using lipopolysaccharides and nigericin sodium salt, then autophagy inhibitors chloroquine (CQ), AMP-activated protein kinase (AMPK) inhibitors compound C (CC) and reactive oxygen species (ROS) scavengers N-acetyl-L-cysteine (NAC) were further used to examine the expression of proteins related to pyroptosis, autophagy and AMPK pathway in MD-treated cells respectively.

RESULTS

MD up-regulated B-cell lymphoma protein 2 (Bax), microtubule-associated protein 1 light chain 3 II (LC3 II), and down-regulated the protein expression levels of B-cell lymphoma-2 (Bcl-2), sequestosome 1 (p62), cleaved-caspase-1, cleaved-interleukin (IL)-1β, and receptor-interacting protein kinase (RIP) 1 in hepatocytes, while it did not significantly affect RIP3. In addition, MD significantly increased the protein expression of liver kinase B1 (LKB1), p-AMPK, and Unc-51-like kinase 1 (ULK1) without significant effect on p-target of rapamycin. Subsequently, the use of CQ increased the protein expression of NOD-like receptor thermal protein domain associated protein 3 (NLRP3), cleaved-caspase-1, and cleaved-IL-1β inhibited by MD; the use of CC significantly decreased the protein expression of MD-induced LC3 II and increased the protein expression of MD-suppressed p62; then the use of NAC decreased the MD-induced p-AMPK protein expression.

CONCLUSION

MD promoted autophagy and apoptosis, but inhibited pyroptosis and necroptosis. MD inhibited pyroptosis may be related regarding the promotion of autophagy. MD activated AMPK by inducing ROS production which in turn promoted autophagy. These results could provide partial theoretical basis for the possible mechanisms of Met in ensuring the normal structure and function of animal organs. Furthermore, ferroptosis is closely related to redox states, it is worth investigating whether MD affects ferroptosis in hepatocytes.

Case report of atypical undernutrition of hypoproteinemia type

Albumin and prealbumin serve as vital markers reflecting hepatic synthesis activity and overall body nutrient status. Hypoproteinemia can result from various etiological factors, with reduced blood inflow into the liver due to portal vein thrombosis being one such cause. However, literature addressing this specific association remains limited. This report presents an atypical case of malnutrition involving a patient who experienced prolonged hypoproteinemia attributable to a gradual decline in hepatic blood perfusion caused by progressive portal thrombosis and cavernous transformation of the portal vein (CTPV). The case encompasses an in-depth analysis of the factors contributing to undernutrition, the etiology and diagnosis of hypoproteinemia, and its clinical implications. Vigilance for the presence of hypoproteinemia is essential in the management of patients afflicted by progressive portal vein thrombosis complicated by CTPV. Timely and effective interventions aimed at rectifying hypoproteinemia can significantly enhance clinical outcomes. Moreover, reduced hepatic blood flow should be considered a plausible underlying cause in cases of unexplained hypoproteinemia, warranting thorough evaluation. This case underscores the importance of recognizing the intricate interplay between hepatic vascular pathology and protein homeostasis in clinical practice.