China L, et al. – This study was performed to examine whether the potentially immune-restorative effects of albumin are mediated by its effects on prostaglandin E2 (PGE2) and other lipids. Analysis of blood samples from acute decompensation and acute on chronic liver failure (AD/ACLF) patients participating in a feasibility study of 20% human albumin solution (HAS) infusions had shown that by binding and inactivating PGE2, infusions to raise serum albumin above 30g/L reversed plasma-mediated immune dysfunction. Moreover, based on lipid profile, the authors described a method to classify the inflammatory response in AD/ACLF that could improve identification of patients most likely to respond to HAS treatment. To determine whether these effects of HAS reduce infections in AD/ACLF, a randomized controlled trial was needed.