Background & Aims
Treatment with albumin in patients with cirrhosis and spontaneous bacterial peritonitis (SBP) prevents renal failure and improves survival. Whether albumin has similar beneficial effects in patients with infections other than SBP is unknown.
One hundred and ten patients with cirrhosis hospitalized for infections other than SBP were randomly assigned to receive antibiotics plus albumin (1.5 g/kg bw at diagnosis and 1 g/kg bw at day 3) (albumin group; n = 56) or antibiotics alone (control group; n = 54). The primary end point was survival at 3 months. Secondary end points were effects on renal and circulatory function.
The renal function, as evaluated by differences in changes in serum creatinine and estimated glomerular filtration rate between the two groups, improved in patients treated with albumin. The circulatory function improved significantly in patients treated with albumin, but not in those from the control group. There was a trend for a lower frequency of type 1 hepatorenal syndrome in the albumin group compared to the control group (1 vs. 4 patients, respectively; p = n.s.). Probability of survival at 3 months was not significantly different among the two groups. However, when adjusted for factors with independent prognostic value, treatment with albumin was an independent predictive factor of survival.
As compared with standard antibiotic therapy alone, treatment with albumin together with antibiotics has beneficial effects on the renal and circulatory function and shows a potential survival benefit. Further studies with large sample sizes should be performed to confirm these findings.
Abbreviations:SBP (spontaneous bacterial peritonitis), PMN (polymorphonuclear), HIV (human immunodeficiency virus), HRS (hepatorenal syndrome), eGFR (estimated glomerular filtration rate), BUN (blood urea nitrogen)
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Hepatology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis.Hepatology. 2002; 35: 140-148
- International Ascites Club. Sepsis in cirrhosis: report on the 7th meeting of the International Ascites Club.Gut. 2005; 54: 718-725
- Bacterial infections, sepsis, and multiorgan failure in cirrhosis.Semin Liver Dis. 2008; 28: 26-42
- Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis.Gastroenterology. 2010; 139: 1246-1256
- Renal impairment after spontaneous bacterial peritonitis in cirrhosis: incidence, clinical course, predictive factors and prognosis.Hepatology. 1994; 20: 1495-1501
- Tumor necrosis factor and interleukin-6 in spontaneous bacterial peritonitis in cirrhosis: relationship with the development of renal impairment and mortality.Hepatology. 1998; 27: 1227-1232
- Severe sepsis in cirrhosis.Hepatology. 2009; 50: 2022-2033
- Albumin infusion for spontaneous bacterial peritonitis.Lancet. 1999; 354: 1838-1839
- Switch therapy with ciprofloxacin vs. intravenous ceftazidime in the treatment of spontaneous bacterial peritonitis in patients with cirrhosis: similar efficacy at lower cost.Aliment Pharmacol Ther. 2006; 23: 75-84
- Renal dysfunction is the most important independent predictor of mortality in cirrhotic patients with spontaneous bacterial peritonitis.Clin Gastroenterol Hepatol. 2011; 9: 260-265
- Renal failure and bacterial infections in patients with cirrhosis: epidemiology and clinical features.Hepatology. 2007; 45: 223-229
- Renal failure in patients with cirrhosis and sepsis unrelated to spontaneous bacterial peritonitis: value of MELD score.Gastroenterology. 2005; 129: 1944-1953
- Renal failure and hyponatremia in patients with cirrhosis and skin and soft tissue infection. A retrospective study.J Hepatol. 2012; 56: 1040-1046
- Systemic, renal, and hepatic hemodynamic derangement in cirrhotic patients with spontaneous bacterial peritonitis.Hepatology. 2003; 38: 1210-1218
- A randomized unblinded pilot study comparing albumin versus hydroxyethyl starch in spontaneous bacterial peritonitis.Hepatology. 2005; 42: 627-634
- Nitric oxide in ascitic fluid is an independent predictor of the development of renal impairment in patients with cirrhosis and spontaneous bacterial peritonitis.Eur J Gastroenterol Hepatol. 2004; 16: 571-577
- High levels of interleukin-6 and its secondary mediators in spontaneous bacterial peritonitis.Gastroenterology. 1993; 105: 310-311
- Effect of intravenous albumin on systemic and hepatic hemodynamics and vasoactive neurohormonal systems in patients with cirrhosis and spontaneous bacterialperitonitis.J Hepatol. 2004; 41: 384-390
- Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis.New Engl J Med. 1999; 341: 403-409
- Human serum albumin: not just a plasma volume expander.Hepatology. 2009; 50: 355-357
- Albumin: biochemical properties and therapeutic potencial.Hepatology. 2005; 41: 1211-1219
- Review article: albumin in the treatment of liver diseases––new features of a classical treatment.Aliment Pharmacol Ther. 2002; 16 (Suppl. 5): 1-5
- Guidelines on the management of ascites in cirrhosis.Gut. 2006; 55 (Suppl. 6): 1-12
- Members of Veterans Affairs Hepatitis C Resource Center Program. Management and treatment of patients with cirrhosis and portal hypertension: recommendations from the Department of Veterans Affairs Hepatitis C Resource Center Program and the National Hepatitis C Program.Am J Gastroenterol. 2009; 104: 1802-1829
- Management of adult patients with ascites due to cirrhosis: an update.Hepatology. 2009; 49: 2087-2107
- European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis.J Hepatol. 2010; 53: 397-417
- Terlipressin plus albumin infusion: an effective and safe therapy of hepatorenal syndrome.J Hepatol. 2000; 33: 43-48
- Reversibility of hepatorenal syndrome by prolonged administration of ornipressin and plasma volume expansion.Hepatology. 1998; 1: 35-41
- Management of bacterial infections in cirrhosis.J Hepatol. 2012; 56: S1-S12
- Management of patients with cirrhosis awaiting liver transplantation.J Hepatol. 2005; 42: S124-S133
- MDRD Study Group. A simplified equation to predict glomerular filtration rate from serum creatinine.J Am Soc Nephrol. 2000; 11: 155A
- 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference.Int Care Med. 2003; 29: 530-538
- Prognostic importance of the cause of renal failure in patients with cirrhosis.Gastroenterology. 2011; 140: 488-496
- Model for end-stage liver disease score and systemic inflammatory response are major prognostic factors in patients with cirrhosis and acute functional renal failure.Hepatology. 2007; 46: 1872-1882
- Serum creatinine and bilirubin predict renal failure and mortality in patients with spontaneous bacterial peritonitis: a retrospective study.Liver Int. 2009; 29: 415-419
- Restricted use of albumin for spontaneous bacterial peritonitis.Gut. 2007; 56: 597-599
Published online: June 25, 2012
Accepted: June 6, 2012
Received in revised form: June 4, 2012
Received: December 16, 2011
☆Clinicaltrials.gov NCT 00124228.
© 2012 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved.