title: Role of albumin treatment in patients with spontaneous bacterial peritonitis.
abstract: OBJECTIVE
  Intravenous administration of albumin decreases the incidence of renal failure and mortality among patients with spontaneous bacterial peritonitis (SBP). However, it is unclear whether it should be given to all patients with SBP; we evaluated its efficacy.
  
  
  METHODS
  We analyzed data from all episodes of SBP (n = 216) during a 7-year period that occurred in a nonselected series of 167 patients with cirrhosis. Low-risk episodes (urea <11 mmol/L and bilirubin <68 μmol/L) were not treated with albumin, whereas high-risk episodes (urea >11 mmol/L and/or bilirubin >68 μmol/L) were or were not given albumin at the discretion of the attending physician.
  
  
  RESULTS
  Sixty-four episodes of SBP (29.6%) were low risk and not treated with albumin, whereas 152 (70.4%) were high risk; 73 of these (48%) were treated with albumin and 79 (52%) were not. Renal failure before SBP resolution was less frequent after low-risk episodes than high-risk episodes (4.7% versus 25.6%; P = .001), in-hospital mortality was lower (3.1% versus 38.2%; P < .001), and the 3-month probability of survival was higher (93% versus 53%; P < .001). In an analysis of only the high-risk group, patients who received albumin had lower in-hospital mortality than those not treated with albumin (28.8% versus 46.8%; P = .02) and a greater 3-month probability of survival (62% versus 45%; P = .01).
  
  
  CONCLUSIONS
  Albumin therapy increases survival of patients who have high-risk episodes of SBP, although it does not seem to be necessary for patients with low risk of death.
authors.affiliation: Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigacions Biomèdiques Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Poca
authors.forename: Mar
authors.initials: M
authors.lastname: Concepción
authors.forename: Meritxell
authors.initials: M
authors.lastname: Casas
authors.forename: Cristina
authors.initials: C
authors.lastname: Alvarez-Urturi
authors.forename: Jordi
authors.initials: J
authors.lastname: Gordillo
authors.forename: Virginia
authors.initials: V
authors.lastname: Hernández-Gea
authors.forename: Eva
authors.initials: E
authors.lastname: Román
authors.forename: Carlos
authors.initials: C
authors.lastname: Guarner-Argente
authors.forename: Ignasi
authors.initials: I
authors.lastname: Gich
authors.forename: German
authors.initials: G
authors.lastname: Soriano
authors.forename: Carlos
authors.initials: C
authors.lastname: Guarner
mesh_terms: D000368:Aged; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D051437:Renal Insufficiency / Q000401:mortality / Q000517:prevention & control*; D012189:Retrospective Studies; D012709:Serum Albumin / Q000008:administration & dosage*; D000075462:Serum Albumin, Human; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: C422455:ALB protein, human; D012709:Serum Albumin; D000075462:Serum Albumin, Human