(99m) Tc-labelled human serum albumin cannot replace (125) I-labelled human serum albumin to determine plasma volume in patients with liver disease

TY - JOUR

T1 - (99m) Tc-labelled human serum albumin cannot replace (125) I-labelled human serum albumin to determine plasma volume in patients with liver disease

AU - Henriksen, Ulrik Lütken

AU - Henriksen, Jens H

AU - Bendtsen, Flemming

AU - Møller, Søren

PY - 2013/5

Y1 - 2013/5

N2 - Background and aims: Determination of plasma volume (PV) is important in several clinical situations. Thus, patients with liver disease often have augmented PV as part of their sodium-water retention. This study was undertaken to compare PV determination by two indicators: technetium-labelled human serum albumin (99mTc-HSA) and iodine-labelled human serum albumin (125I-HSA), as the former may have advantages at repeated measurements and the latter is the classical gold standard. Study population and methods: In 88 patients, (64 with liver disease, mainly cirrhosis, and 24 patients without liver disease), simultaneous measurements of PV were taken with 99mTc-HSA and 125I-HSA after 1 h in the supine position. Blood samples were obtained before and 10 min after quantitative injection of the two indicators. In a subset of patients (n = 32), the measurements were repeated within 1 h. Results: In all patients, a close correlation was present between PV determined by the two indicators (r = 0·89, P<0·0001). In all, but twelve patients, a higher PV was obtained with 99mTc-HSA compared with 125I-HSA (P<0·0001). PV determined with 99mTc-HSA exceeded PV determined with 125I-HSA by 367 ml (5·2 ml kg-1) in liver patients as compared to 260 ml (3·5 ml kg-1) in patients without liver disease (P<0·05). The precision of repeated PV determination was 1·75% (coefficient of variation) with 99mTc-HSA and 1·71% with 125I-HSA (ns), and similar values were found in patients with and without liver disease. Conclusion: The study demonstrates that 99mTc-HSA has the same precision as that of 125I-HSA. However, especially in patients with liver disease, 99mTc-HSA consistently overestimates the PV, most likely owing to indicator heterogeneity with subsequent fast removal from the circulating medium with a higher volume of distribution as the outcome.

AB - Background and aims: Determination of plasma volume (PV) is important in several clinical situations. Thus, patients with liver disease often have augmented PV as part of their sodium-water retention. This study was undertaken to compare PV determination by two indicators: technetium-labelled human serum albumin (99mTc-HSA) and iodine-labelled human serum albumin (125I-HSA), as the former may have advantages at repeated measurements and the latter is the classical gold standard. Study population and methods: In 88 patients, (64 with liver disease, mainly cirrhosis, and 24 patients without liver disease), simultaneous measurements of PV were taken with 99mTc-HSA and 125I-HSA after 1 h in the supine position. Blood samples were obtained before and 10 min after quantitative injection of the two indicators. In a subset of patients (n = 32), the measurements were repeated within 1 h. Results: In all patients, a close correlation was present between PV determined by the two indicators (r = 0·89, P<0·0001). In all, but twelve patients, a higher PV was obtained with 99mTc-HSA compared with 125I-HSA (P<0·0001). PV determined with 99mTc-HSA exceeded PV determined with 125I-HSA by 367 ml (5·2 ml kg-1) in liver patients as compared to 260 ml (3·5 ml kg-1) in patients without liver disease (P<0·05). The precision of repeated PV determination was 1·75% (coefficient of variation) with 99mTc-HSA and 1·71% with 125I-HSA (ns), and similar values were found in patients with and without liver disease. Conclusion: The study demonstrates that 99mTc-HSA has the same precision as that of 125I-HSA. However, especially in patients with liver disease, 99mTc-HSA consistently overestimates the PV, most likely owing to indicator heterogeneity with subsequent fast removal from the circulating medium with a higher volume of distribution as the outcome.

U2 - 10.1111/cpf.12015

DO - 10.1111/cpf.12015

M3 - Journal article

C2 - 23522015

SN - 1475-0961

VL - 33

SP - 211

EP - 217

JO - Clinical Physiology and Functional Imaging

JF - Clinical Physiology and Functional Imaging

IS - 3

ER -