Effect of Intravenous Albumin on Renal Impairment and Mortality in Patients with Cirrhosis and Spontaneous Bacterial Peritonitis

doi:10.1056/NEJM199908053410603

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Effect of Intravenous Albumin on Renal Impairment and Mortality in Patients with Cirrhosis and Spontaneous Bacterial Peritonitis

Journal Article•DOI•

Effect of Intravenous Albumin on Renal Impairment and Mortality in Patients with Cirrhosis and Spontaneous Bacterial Peritonitis

Pau Sort, Miquel Navasa, Vicente Arroyo, Xavier Aldeguer, Ramon Planas, Luis Ruiz-del-Arbol, Lluis Castells, Victor Vargas, Germán Soriano, Mónica Guevara, Pere Ginès, Joan Rodés - Show less +8 more

05 Aug 1999-The New England Journal of Medicine (Massachusetts Medical Society)-Vol. 341, Iss: 6, pp 403-409

TL;DR: In patients with cirrhosis and spontaneous bacterial peritonitis, treatment with intravenous albumin in addition to an antibiotic reduces the incidence of renal impairment and death in comparison with treatment with an antibiotic alone.

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Abstract: Background In patients with cirrhosis and spontaneous bacterial peritonitis, renal function frequently becomes impaired. This impairment is probably related to a reduction in effective arterial blood volume and is associated with a high mortality rate. We conducted a study to determine whether plasma volume expansion with intravenous albumin prevents renal impairment and reduces mortality in these patients. Methods We randomly assigned 126 patients with cirrhosis and spontaneous bacterial peritonitis to treatment with intravenous cefotaxime (63 patients) or cefotaxime and intravenous albumin (63 patients). Cefotaxime was given daily in doses that varied according to the serum creatinine level, and albumin was given at a dose of 1.5 g per kilogram of body weight at the time of diagnosis, followed by 1 g per kilogram on day 3. Renal impairment was defined as nonreversible deterioration of renal function during hospitalization. Results The infection resolved in 59 patients in the cefotaxime group (94 percent...

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Journal Article•DOI•

Acute kidney injury

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Rinaldo Bellomo¹, John A. Kellum², Claudio Ronco•Institutions (2)

Monash University¹, University of Pittsburgh²

25 Aug 2012-The Lancet

TL;DR: Evidence suggests that patients who have had acute kidney injury are at increased risk of subsequent chronic kidney disease, and new diagnostic techniques (eg, renal biomarkers) might help with early diagnosis.

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1,840 citations

Journal Article•DOI•

EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis

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Paolo Angeli, Mauro Bernardi, Càndid Villanueva, Claire Francoz, Rajeshwar P. Mookerjee, Jonel Trebicka, Aleksander Krag, Wim Laleman, Pere Ginès - Show less +5 more

01 Aug 2018-Journal of Hepatology

TL;DR: The panel of experts, having emphasised the importance of initiating aetiologic treatment for any degree of hepatic disease at the earliest possible stage, extended its work to all the complications of cirrhosis which had not been covered by the European Association for the Study of the Liver guidelines.

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1,534 citations

Cites background from "Effect of Intravenous Albumin on Re..."

...albumin is useful in patients with baseline bilirubin <68 lmol/L and creatinine <88 lmol/L, as the incidence of type 1 HRS in patients meeting these criteria was very low in the two treatment groups (7% without albumin and 0% with albumin).(272) The application of the schedule of this therapeutic option should be implemented in clinical practice....
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...SBP without septic shock may precipitate deterioration of circulatory function with severe liver failure, hepatic encephalopathy, and type 1 HRS and has approximately 20% hospital mortality despite infection resolution.(272) A randomised, controlled study in patients with SBP treated with cefotaxime showed that albumin (1....
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Journal Article•DOI•

EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis.

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Sören Möller

30 Aug 2010-Journal of Hepatology

TL;DR: There is a clear rationale for the management of ascites in patients with cirrhosis, as successful treatment may improve outcome and symptoms, and patients with ascites should generally be considered for referral for liver transplantation.

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1,476 citations

Cites background from "Effect of Intravenous Albumin on Re..."

...The development of bacterial infections, particulary SBP, is the most important risk factor for HRS [121,127,197,198]....
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...HRS develops in approximately 30% of patients who develop SBP [121]....
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...Treatment of SBP with albumin infusion together with antibiotics reduces the risk of developing HRS and improves survival [121]....
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...Sort, 1999 [121] Cefotaxime (2 g/6h IV) versus cefotaxime (2 g/6h IV) plus IV albumin 63 94 71 63 98 90...
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...Until further trials are completed, albumin infusion appears a valuable adjunction to the treatment of SBP. Recommendations HRS occurs in approximately 30% of patients with SBP treated with antibiotics alone, and is associated with a poor survival....
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Journal Article•DOI•

Human serum albumin: from bench to bedside.

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Gabriella Fanali¹, Alessandra di Masi², Viviana Trezza², Maria Marino², Mauro Fasano¹, Paolo Ascenzi² - Show less +2 more•Institutions (2)

University of Insubria¹, Roma Tre University²

01 Jun 2012-Molecular Aspects of Medicine

TL;DR: HSA is a valuable biomarker of many diseases, including cancer, rheumatoid arthritis, ischemia, post-menopausal obesity, severe acute graft-versus-host disease, and diseases that need monitoring of the glycemic control.

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1,257 citations

Journal Article•DOI•

Infections in Patients With Cirrhosis Increase Mortality Four-Fold and Should Be Used in Determining Prognosis

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Vasiliki Arvaniti¹, Gennaro D'Amico, Giuseppe Fede¹, Pinelopi Manousou¹, Emmanuel Tsochatzis¹, M. Pleguezuelo¹, Andrew K. Burroughs¹ - Show less +3 more•Institutions (1)

University College London¹

01 Oct 2010-Gastroenterology

TL;DR: In patients with cirrhosis, infections increase mortality 4-fold; 30% of patients die within 1 month after infection and another 30% die by 1 year; prospects with prolonged follow-up evaluation and to evaluate preventative strategies are needed.

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929 citations

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References

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Open Access

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Journal Article•DOI•

Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis

[...]

Vicente Arroyo, Pere Ginès, Alexander L. Gerbes, F J Dudley, Paolo Gentilini, Giacomo Laffi, Telfer B. Reynolds, H. Ring-Larsen, J Schölmerich - Show less +5 more

01 Jan 1996-Hepatology

1,530 citations

Journal Article•DOI•

Peripheral arterial vasodilation hypothesis: a proposal for the initiation of renal sodium and water retention in cirrhosis.

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Robert W. Schrier, Vicente Arroyo, Mauro Bernardi, Murray Epstein, Jens H. Henriksen, Joan Rodés - Show less +2 more

01 Sep 1988-Hepatology

TL;DR: The stimulation of the renin‐angiotensin‐aldosterone system, vasopressin release and sympathetic nervous system associated with cirrhosis is not consonant with primary volume expansion, and favors the “overflow” hypothesis.

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1,475 citations

Journal Article•DOI•

The cardiovascular response of normal humans to the administration of endotoxin

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Anthony F. Suffredini¹, Robert E. Fromm, Margaret M. Parker, Matthew Brenner, Joseph A. Kovacs, Robert Wesley, Joseph E. Parrillo - Show less +3 more•Institutions (1)

National Institutes of Health¹

03 Aug 1989-The New England Journal of Medicine

TL;DR: It is concluded that the administration of endotoxin to normal subjects causes a depression ofleft ventricular function that is independent of changes in left ventricular volume or vascular resistance, and suggests that endotoxin is a major mediator of the cardiovascular dysfunction in this condition.

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Abstract: Marked abnormalities in cardiovascular function accompany septic shock, and bacterial endotoxin is believed to be one of the principal mediators of these abnormalities. To evaluate the cardiovascular effects of endotoxemia in humans, we measured hemodynamic variables in nine normal subjects given an intravenous bolus dose of endotoxin (Escherichia coli, 4 ng per kilogram of body weight) and in six normal subjects given a bolus dose of saline, before and three hours after administration. All the subjects then underwent volume loading with normal saline (mean, 2217 ml) during the fourth and fifth hours after administration of the bolus, and the measurements were repeated. Three hours after the administration of endotoxin and before volume loading, the cardiac index had increased by 53 percent and the heart rate by 36 percent (both changes were significant; P less than or equal to 0.008), and the systemic vascular-resistance index had decreased by 46 percent (P = 0.004). After volume loading (five hours after the administration of endotoxin), the left ventricular ejection fraction decreased by 1 percent of the base-line value in the subjects given endotoxin, but increased by 14 percent in the controls (P = 0.008). The left ventricular end-diastolic and end-systolic volume indexes increased by 18 percent (P = 0.07) and 24 percent (P = 0.042), respectively. Left ventricular performance, as measured by the ratio of the peak systolic pressure to the end-systolic volume index, was depressed (a decrease of 0.90 in the subjects given endotoxin vs. an increase of 0.76 in the controls; P = 0.024). We conclude that the administration of endotoxin to normal subjects causes a depression of left ventricular function that is independent of changes in left ventricular volume or vascular resistance. The changes in function are similar to those observed in septic shock and suggest that endotoxin is a major mediator of the cardiovascular dysfunction in this condition.

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1,077 citations

Journal Article•DOI•

Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis: Results of a double‐blind, placebo‐controlled trial

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Pere Ginès, Antoni Rimola, Ramon Planas, Victor Vargas, Francesc Marco, Manuel Almela, Montserrat Forné, Maria Luisa Miranda, Josep Llach, Joan Manuel Salmerón, Maria Esteve, Josep Maria Marques, María Teresa Jiménez de Anta, Vicente Arroyo, Joan Rodés - Show less +11 more

01 Oct 1990-Hepatology

TL;DR: Results indicate that long‐term selective intestinal decontamination with norfloxacin is an effective and safe measure to prevent spontaneous bacterial peritonitis recurrence caused by aerobic gram‐negative bacilli in cirrhosis.

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574 citations

Journal Article•DOI•

Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis

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Angels Ginès, Gloria Fernández-Esparrach, Alberto Monescillo, Carmen Vila, Eugeni Domènech, Raquel Abecasis, Paolo Angeli, Luis Ruiz-del-Arbol, Ramon Planas, Ricard Solà, Pere Ginès, R. Terg, L Inglada, P Vaque, Francesco Salerno, Victor Vargas, Gerardo Clemente, J. Quer, Wladimiro Jiménez, V. Arroyo, Joan Rodés - Show less +17 more

01 Oct 1996-Gastroenterology

TL;DR: Postparacentesis circulatory dysfunction is not spontaneously reversible and is associated with a shorter time to first readmission and shorter survival, and albumin is the best plasma expander to prevent this complication.

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561 citations