Effect of intravenous albumin on systemic and hepatic hemodynamics and vasoactive neurohormonal systems in patients with cirrhosis and spontaneous bacterial peritonitis.
OBJECTIVE
Albumin administration prevents renal failure and improves survival in spontaneous bacterial peritonitis. This study characterizes the mechanisms of action of albumin in this condition.


METHODS
Systemic and splanchnic hemodynamics, plasma renin activity and plasma concentration of interleukin-6, serum concentration of nitric oxide and ascitic fluid levels of nitric oxide and interleukin-6 were assessed at diagnosis and resolution of infection in 12 patients with spontaneous bacterial peritonitis treated with ceftriaxone plus albumin. At infection resolution there was a significant improvement in circulatory function, as indicated by a significant increase in mean arterial pressure (+8%, P=0.02), a fall in heart rate (-10%, P=0.01), a suppression of plasma renin activity (-67%, P=0.002) and a decrease in creatinine levels. These changes were related to both an increase in cardiac work (stroke work index: +18%, P=0.005) and in peripheral vascular resistance (+14%, P=0.05). The improvement in cardiac function was due to an increase in filling. No significant changes were observed in portal pressure or hepatic blood flow.


CONCLUSIONS
These results indicate that the beneficial effects of albumin administration on systemic hemodynamics and renal function in spontaneous bacterial peritonitis are related to both an improvement in cardiac function and a decrease in the degree of arterial vasodilation.
Fernández
Javier
J
Liver Unit, IMD, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain. jfdez@clinic.ub.es
Navasa
Miguel
M
Garcia-Pagan
Juan Carlos
JC
G-Abraldes
Juan
J
Jiménez
Wladimiro
W
Bosch
Jaume
J
Arroyo
Vicente
V
D000328:Adult; D000368:Aged; D000418:Albumins / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001202:Ascitic Fluid / Q000378:metabolism; D001424:Bacterial Infections / Q000150:complications* / Q000188:drug therapy*; D002443:Ceftriaxone / Q000627:therapeutic use; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007275:Injections, Intravenous; D015850:Interleukin-6 / Q000097:blood / Q000378:metabolism; D008102:Liver Circulation / Q000187:drug effects; D008103:Liver Cirrhosis / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000097:blood / Q000378:metabolism; D010538:Peritonitis / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D012083:Renin / Q000097:blood
D000418:Albumins; D000900:Anti-Bacterial Agents; D015850:Interleukin-6; D009569:Nitric Oxide; D002443:Ceftriaxone; D012083:Renin