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Liver disease is now the third most common cause of premature death in the UK and the majority of patients will die in hospital due to bacterial infection. Derek Gilroy and I demonstrated that Prostaglandin E2 is a key mediator of leukocyte function in these patients (Nature Medicine 2014). This is bound by the plasma protein albumin which is reduced in patients with liver disease. This work led directly to our 40 site UK-wide clinical trial of albumin infusions to reduce incidence and complications of infection which represents the largest trial ever performed in this group of patients (NEJM 2021). The overall result was null and so we embarked on a further large scale trial of primary prophylaxis of cotrimoxazole to improve survival by reducing infection. We have now completed recruitment and the results will be available in 2025.
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JHEP Reportsno. 8 (2023): 100785-100785
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EClinicalMedicine (2023): 101924-101924
Journal of hepatologyno. 6 (2022): 1306-1317
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