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Albumin for bacterial infections other than spontaneous bacterial peritonitis in cirrhosis. A randomized, controlled study

  • Author Footnotes
    † These authors contributed equally to this work.
    Mónica Guevara
    Footnotes
    † These authors contributed equally to this work.
    Affiliations
    Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain

    Institut d’Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain

    Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain

    Instituto Reina Sofía de Investigación Nefrológica (IRSIN), Spain
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  • Author Footnotes
    † These authors contributed equally to this work.
    Carlos Terra
    Footnotes
    † These authors contributed equally to this work.
    Affiliations
    Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain

    Institut d’Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain

    Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain

    Instituto Reina Sofía de Investigación Nefrológica (IRSIN), Spain
    Search for articles by this author
  • André Nazar
    Affiliations
    Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain

    Institut d’Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain

    Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain

    Instituto Reina Sofía de Investigación Nefrológica (IRSIN), Spain
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  • Elsa Solà
    Affiliations
    Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain

    Institut d’Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain

    Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain

    Instituto Reina Sofía de Investigación Nefrológica (IRSIN), Spain
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  • Javier Fernández
    Affiliations
    Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain

    Institut d’Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain

    Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
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  • Marco Pavesi
    Affiliations
    Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain

    Institut d’Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain

    Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
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  • Vicente Arroyo
    Affiliations
    Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain

    Institut d’Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain

    Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
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  • Pere Ginès
    Correspondence
    Corresponding author. Address: Liver Unit, Hospital Clínic Villarroel 170, 08036 Barcelona, Spain.
    Affiliations
    Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Catalunya, Spain

    Institut d’Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain

    Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain

    Instituto Reina Sofía de Investigación Nefrológica (IRSIN), Spain
    Search for articles by this author
  • Author Footnotes
    † These authors contributed equally to this work.

      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.

      Methods

      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.

      Results

      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.

      Conclusions

      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)

      Keywords

      Linked Article

      • Effect of albumin on survival in septic cirrhotic patients other than spontaneous bacterial peritonitis. The question remains open
        Journal of HepatologyVol. 58Issue 3
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          We read the manuscript by Guevara et al. with interest [1]. The authors evaluated the effect of albumin administration on the 3-month survival in cirrhotic patients hospitalized for infections other than spontaneous bacterial peritonitis (SBP). After randomization, 54 and 56 patients received respectively antibiotics alone, and both antibiotics plus intravenous albumin (1.5 g/kg the first day and 1 g/kg at day 3). The authors concluded that albumin administration with antibiotics showed a potential survival benefit in per-protocol analysis as compared with the control group, and that such a beneficial effect was probably due to the improvement in effective arterial blood volume reflected by the improvement in renal function.
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      • Reply to: “Effect of albumin on survival in septic cirrhotic patients other than spontaneous bacterial peritonitis. The question remains open”
        Journal of HepatologyVol. 58Issue 3
        • Preview
          We would like to thank Dr. Thevenot et al. for their interest in our study on the effect of albumin administration in patients with cirrhosis and infections other than spontaneous bacterial peritonitis [1]. Our answers to their comments are as follows: (1) the statistical difference between the per-protocol analysis and intention-to-treat analysis is minimal, as indicated by their corresponding hazard ratios (0.29 and 0.35, respectively) and p values (0.042 and 0.06), despite the fact that the latter falls outside the level of significance.
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