Albumin Infusion Improves Outcomes of Patients with Spontaneous Bacterial Peritonitis: A Meta-Analysis of Randomized Trials.
Clin Gastroenterol Hepatol. 2012 Nov 21;
Authors: Salerno F, Navickis RJ, Wilkes MM
Abstract
BACKGROUND & AIMS: Renal impairment increases mortality among patients with spontaneous bacterial peritonitis (SBP), despite administration of non-nephrotoxic antibiotics. Albumin infusion has been reported to reduce renal impairment and mortality in patients with SBP. We performed a meta-analysis of randomized controlled trials (RCTs) to quantify the effect of albumin infusion on renal impairment and mortality in patients with SBP. METHODS: We searched MEDLINE, EMBASE, the Cochrane Library, and ClinicalTrials.gov for RCTs that evaluated albumin treatment for patients with SBP; we also performed non-electronic searches for articles. Four trials, of 288 total patients, were included in our analysis. Data were quantitatively combined under a fixed effects model. RESULTS: We found no evidence of statistically significant heterogeneity or publication bias among the studies analyzed. Albumin was compared with no albumin in 3 trials and with artificial colloid in 1 trial. All patients received antibiotics. The incidence of renal impairment in control groups was 44/144 (30.6%) compared with 12/144 (8.3%) in groups given albumin. The pooled odds ratio for a reduction in renal impairment following albumin infusion was 0.21 (95% confidence interval [CI], 0.11-0.42). Odds ratios for renal impairment following albumin therapy ranged from 0.19 to 0.30 among the studies. Mortality among controls was 51/144 (35.4%), compared with 23/144 (16.0%) among patients who received albumin. The pooled odds ratio for decreased mortality following infusion of albumin was 0.34 (95% CI, 0.19-0.60). Odds ratios for mortality in individual RCTs ranged from 0.16 to 0.55. CONCLUSIONS: In a meta-analysis of 4 RCTs (288 patients), albumin infusion prevented renal impairment and reduced mortality among patients with SBP.
PMID: 23178229 [PubMed - as supplied by publisher]