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

TitreEffect of albumin in cirrhotic patients with infection other than spontaneous bacterial peritonitis. A randomized trial
Type de publicationArticle de revue
AuteurThevenot, Thierry, Bureau, Christophe, Oberti, Frédéric , Anty, Rodolphe, Louvet, Alexandre, Plessier, Aurélie, Rudler, Marika, Heurgue-Berlot, Alexandra, Rosa, Isabelle, Talbodec, Nathalie, Dao, Thong, Ozenne, Violaine, Carbonell, Nicolas, Causse, Xavier, Goria, Odile, Minello, Anne, de Ledinghen, Victor, Amathieu, Roland, Barraud, Helene, Nguyen-Khac, Eric, Becker, Claire, Paupard, Thierry, Botta-Fridlung, Danielle, Abdelli, Naceur, Guillemot, François, Monnet, Elisabeth, Di Martino, Vincent
EditeurElsevier
TypeArticle scientifique dans une revue à comité de lecture
Année2015
LangueAnglais
DateAvril 2015
Numéro4
Pagination822-30
Volume62
Titre de la revueJournal of Hepatology
ISSN1600-0641
Mots-clésAdult, Albumins, Anti-Bacterial Agents, Bacterial Infections, Female, Humans, Infusions, Intravenous, Kidney Function Tests, Liver Cirrhosis, Liver Function Tests, Male, Middle Aged, Renal Insufficiency, Sepsis, Survival rate, Treatment Outcome
Résumé en anglais

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.

URL de la noticehttp://okina.univ-angers.fr/publications/ua18973
DOI10.1016/j.jhep.2014.11.017
Lien vers le document

https://www.journal-of-hepatology.eu/article/S0168-8278(14)00862-9/fulltext

Autre titreJ. Hepatol.
Identifiant (ID) PubMed25463545