Synthesis of
plasma proteins is an important function of the liver that has sparsely been investigated by modern techniques in patients with advanced chronic
liver disease (CLD). Twenty-eight well-characterized patients with CLD under evaluation for
liver transplantation were included.
Albumin and
fibrinogen synthesis rates were measured by the flooding dose technique using stable
isotope-labeled
phenylalanine. Transcapillary escape rate of
albumin and plasma volume were assessed by radioiodinated
human serum albumin. The absolute
albumin synthesis rates were low (65 mg/kg/day, range: 32-203) and were associated with impaired liver function, as reflected by the risk-scores Child-Pugh (P = 0.025) and model for
end-stage liver disease (rs = -0.62, P = 0.0005). The
fibrinogen synthesis rate (12.8 mg/kg/day, range: 2.4-52.9) was also negatively associated with liver function. The synthesis rates of
albumin and
fibrinogen were positively correlated. Plasma volume was high (51 ± 9 mL/kg body wt), which contributed to an almost normal intravascular
albumin mass despite low plasma concentration. Autoimmune inflammatory etiologies to CLD were associated with higher
fibrinogen synthesis. De novo synthesis rates of
albumin and
fibrinogen in advanced
chronic liver failure were negatively correlated to prognostic scores of
liver disease.
Albumin synthesis rate was low and associated with both
liver failure and autoimmune
inflammation, whereas
fibrinogen synthesis was often normal and positively associated with chronic
inflammation. This is different from acute inflammatory states in which both
albumin and
fibrinogen synthesis rates are high.NEW & NOTEWORTHY
Albumin and
fibrinogen synthesis were positively correlated, but the high variation indicates that these are probably influenced by different mechanisms. There might be a limited metabolic reserve for the liver to increase both
albumin and
fibrinogen synthesis in response to longstanding
inflammation in CLD and
fibrinogen seems to be prioritized.