Role of Albumin Treatment in Patients with Spontaneous Bacterial Peritonitis.
Clin Gastroenterol Hepatol. 2011 Nov 14;
Authors: Poca M, Concepción M, Casas M, Alvarez-Urturi C, Gordillo J, Hernández-Gea V, Román E, Guarner-Argente C, Gich I, Soriano G, Guarner C
BACKGROUND & AIMS: Intravenous administration of albumin decreases the incidence of renal failure and mortality among patients with spontaneous bacterial peritonitis (SBP). However, it is unclear whether it should be given to all patients with SBP; we evaluated its efficacy. METHODS: We analyzed data from all episodes of SBP (n=216) over a 7-year period that occurred in a non-selected series of 167 patients with cirrhosis. Low-risk episodes (urea <11 mmol/l and bilirubin <68 µmol/l) were not treated with albumin whereas high-risk episodes (urea >11 mmol/l and/or bilirubin >68 µmol/l) were or were not given albumin, at the discretion of the attending physician. RESULTS: Sixty-four episodes of SBP were low risk (29.6%) and not treated with albumin whereas 152 were high risk (70.4%); 73 of these were treated with albumin (48%) and 79 were not (52%). Renal failure before SBP resolution was less frequent following low-risk episodes than high-risk episodes (4.7% vs 25.6%; P=.001), in-hospital mortality was lower (3.1% vs 38.2%; P <.001), and the 3-month probability of survival was higher (93% vs 53%; P<.001). In an analysis of only the high-risk group, patients that received albumin had lower in-hospital mortality than those not treated with albumin (28.8% vs 46.8%; P=0.02) and a greater percentage survived for 3 months (62% vs 45%; P=0.01). CONCLUSIONS: Albumin therapy increases survival of patients who have high-risk episodes of SBP, although it doesn't seem to be necessary for patients with low risk of death.
PMID: 22094025 [PubMed - as supplied by publisher]