Reuters Health Information (2012-07-13): Albumin beneficial in cirrhosis patients with bacterial infections
Albumin beneficial in cirrhosis patients with bacterial infections
Last Updated: 2012-07-13 15:40:30 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Adding albumin to antibiotic therapy helps cirrhosis patients with spontaneous bacterial infections, researchers from Spain have found.
"The results of our study indicate that albumin administration improves renal and circulatory function in patients with cirrhosis and infections other than spontaneous bacterial peritonitis (SBP)," Dr. Pere Gines from the University of Barcelona told Reuters Health by email.
"The survival benefit shown in the study is small," he added. "Ideally, these results should be confirmed in larger studies and in different settings before this treatment approach becomes the standard of care in this clinical situation."
The new findings were published online June 22 in the Journal of Hepatology. Previous studies showed that administration of albumin to cirrhotic patients with SBP prevents the deleterious effects on circulatory function and the development of renal failure and also improves survival. As a consequence, guidelines recommend giving albumin to such patients.
In a study of 110 patients with cirrhosis, Dr. Gines and colleagues investigated whether albumin also improves survival and protects against circulatory and renal failure in bacterial infections other than SBP.
Serum creatinine levels were lower throughout the 14-day study period in patients randomly assigned to albumin and antibiotics than in patients getting antibiotics only. But the difference was statistically significant only at days 3 and 7.
Twenty of 97 patients had renal failure upon entry into the study (10 in each treatment group). Renal failure was reversible in patients in the albumin group, compared with six in the control group.
Among the 77 patients who did not have renal failure at inclusion, four (10%) in the control group and one (3%) in the albumin group developed renal failure (the difference was not statistically significant).
Plasma renin activity, plasma aldosterone, and norepinephrine levels decreased significantly in the albumin group while plasma atrial natriuretic peptide levels increased, suggesting improved effective arterial blood volume. There were no significant changes in the control group.
Mean arterial pressure decreased significantly from baseline to day 7 in the control group, but remained stable in the albumin group.
At the end of the three-month follow-up, 10 patients in the control group and 8 in the albumin group had died, but there was no significant difference in unadjusted survival rates between the treatment groups.
Three-month mortality was significantly higher in patients with renal failure than in those without (56% vs. 19%, p<0.001). And after adjustment for other potential confounders, albumin treatment appeared to predict improved survival (p=0.04).
"Prevention of impairment of kidney function is essential to reduce mortality in cirrhosis," Dr. Gin�s said.
"We have planned to perform a larger multicenter study in the setting of the EASL-CLIF consortium (European Association For The Study Of The Liver-Chronic Liver Failure Consortium) to confirm our findings," Dr. Gin�s said.
J Hepatol 2012.