Effect of albumin in cirrhotic patients with infection other than spontaneous bacterial peritonitis. A randomized trial.

Abstract

BACKGROUND & AIMS:

Albumin infusion improves renal function and survival in cirrhotic patients with spontaneous bacterial peritonitis (SBP) but its efficacy in other types of infections remains unknown. We investigated this issue through a multicenter randomized controlled trial.

METHODS:

A total of 193 cirrhotic patients with a Child-Pugh score greater than 8 and sepsis unrelated to SBP were randomly assigned to receive antibiotics plus albumin (1.5 g/kg on day 1 and 1g/kg on day 3; albumin group [ALB]: n=96) or antibiotics alone (control group [CG]: n=97). The primary endpoint was the 3-month renal failure rate (increase in creatinine ⩾50% to reach a final value ⩾133 μmol/L). The secondary endpoint was 3-month survival rate.

RESULTS:

Forty-seven (24.6%) patients died (ALB: n=27 vs. CG: n=20; 3-month survival: 70.2% vs. 78.3%; p=0.16). Albumin infusion delayed the occurrence of renal failure (mean time to onset, ALB: 29.0 ± 21.8 vs. 11.7 ± 9.1 days, p=0.018) but the 3-month renal failure rate was similar (ALB: 14.3% vs. CG: 13.5%; p=0.88). By multivariate analysis, MELD score (p<0.0001), pneumonia (p=0.0041), hyponatremia (p=0.031) and occurrence of renal failure (p<0.0001) were predictors of death. Of note, pulmonary edema developed in 8/96 (8.3%) patients in the albumin group of whom two died, one on the day and the other on day 33 following albumin infusion.

CONCLUSIONS:

In cirrhotic patients with infections other than SBP, albumin infusion delayed onset of renal failure but did not improve renal function or survival at 3 months. Infusion of large amounts of albumin should be cautiously administered in the sickest cirrhotic patients.

• Authors: Thierry Thévenot, Christophe Bureau, Frédéric Oberti, Rodolphe Anty, Alexandre Louvet, Aurélie Plessier, Marika Rudler, Alexandra Heurgué-Berlot, Isabelle Rosa, Nathalie Talbodec, Thong Dao, Violaine Ozenne, Nicolas Carbonell, Xavier Causse, Odile Goria, Anne Minello, Victor De Ledinghen, Roland Amathieu, Hélène Barraud, Eric Nguyen-Khac, Claire Becker, Thierry Paupard, Danielle Botta-Fridlung, Naceur Abdelli, François Guillemot, Elisabeth Monnet, Vincent Di Martino
• Journal: Journal of hepatology (J Hepatol) Vol. 62 Issue 4 Pg. 822-30 (Apr 2015) ISSN: 1600-0641 [Electronic] Netherlands
• PMID: 25463545 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Chemical References

• Albumins
• Anti-Bacterial Agents

Topics

• Adult
• Albumins (administration & dosage)
• Anti-Bacterial Agents (administration & dosage)
• Bacterial Infections (drug therapy, etiology)
• Female
• Humans
• Infusions, Intravenous
• Kidney Function Tests (methods)
• Liver Cirrhosis (complications)
• Liver Function Tests
• Male
• Middle Aged
• Renal Insufficiency (diagnosis, etiology, prevention & control)
• Sepsis (drug therapy, etiology)
• Survival Rate
• Treatment Outcome