"Albumin Infusion in Patients with Cirrhosis and Spontaneous Bacterial Peritonitis".The New England Journal of Medicine. 1999. 341(6):403-409.
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Contents 1Clinical Question 2Bottom Line 3Major Points 4Guidelines 5Design 6Population 6.1Inclusion Criteria 6.2Exclusion Criteria 6.3Baseline Characteristics 7Interventions 8Outcomes 8.1Primary Outcomes 8.2Secondary Outcomes 9Funding 10Further Reading
In patients with cirrhosis and spontaneous bacterial peritonitis, does plasma volume expansion with intravenous albumin prevent renal impairment and reduce mortality?
In patients with cirrhosis and spontaneous bacterial peritonitis, treatment with intravenous albumin in addition to antibiotics significantly decreases the incidence of renal impairment and improves survival compared with antibiotics alone.
Spontaneous bacterial peritonitis is a severe complication in patients with cirrhosis. One-third of these patients develop renal impairment during the infection despite non-nephrotoxic antibiotic treatment, which is associated with higher mortality. Plasma volume expansion with albumin may enhance arterial blood volume, thus preventing circulatory dysfunction and kidney damage.
As of the current knowledge cutoff, the updated guidelines reflecting the results of this study have not been provided.
Multicenter, double-blind, randomized, controlled trial.
N=126 patients with cirrhosis and spontaneous bacterial peritonitis.
Inclusion Criteria - Polymorphonuclear-cell count in ascitic fluid >250/mm^3 - Age between 18 and 80 years - Serum creatinine ≤3 mg/dL (265 μmol/L)
Exclusion Criteria - Antibiotic treatment within one week before diagnosis - Other infections, shock, severe hepatic encephalopathy, cardiac failure, organic nephropathy, HIV - Dehydration causes within one week before diagnosis
Baseline Characteristics The groups were well-matched in terms of clinical and laboratory data at enrollment.
Two groups: cefotaxime alone (n=63) vs. cefotaxime and intravenous albumin (n=63).
Primary Outcomes - Development of renal impairment - Mortality during hospitalization and at three months
- Resolution of infection - Increased plasma renin activity
Supported by grants from the Fondo de Investigación Sanitaria (FIS 94/0956 and FIS 96/1723) and the Hospital Clínic.
Original article in The New England Journal of Medicine, 1999. 341(6):403-409.