title: Effect of albumin in cirrhotic patients with infection other than spontaneous bacterial peritonitis. A randomized trial.
abstract: OBJECTIVE
  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.
authors.affiliation: Service d'Hépatologie, hôpital Jean Minjoz, 25000 Besançon, France. Electronic address: tthevenot@chu-besancon.fr.
authors.forename: Thierry
authors.initials: T
authors.lastname: Thévenot
authors.affiliation: Service d'Hépato-Gastroentérologie, hôpital Purpan, clinique Dieulafoy, 31059 Toulouse, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Bureau
authors.affiliation: Service d' d'Hépato-Gastroentérologie, hôpital d'Angers, 4 rue Larrey, 49100 Angers, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Oberti
authors.affiliation: Service d'Hépato-Gastroentérologie, hôpital Archet, rue St Antoine Ginestier, 06200 Nice, France.
authors.forename: Rodolphe
authors.initials: R
authors.lastname: Anty
authors.affiliation: Service des Maladies de l'Appareil Digestif, CHRU de Lille, rue M. Polonovs.ki, 59037 Lille cedex, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Louvet
authors.affiliation: Inserm U-773, Service d'Hépatologie, hôpital Beaujon, 100 boulevard du Général Leclerc, 92118 Clichy cédex, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Plessier
authors.affiliation: Service d'Hépato-Gastroentérologie, hôpital Pitié-Salpétrière, 47-83 boulevard de l'Hôpital, 75651 Paris cedex 13, France.
authors.forename: Marika
authors.initials: M
authors.lastname: Rudler
authors.affiliation: Service d'Hépato-Gastroentérologie, hôpital Robert Debré, 51092 Reims cedex, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Heurgué-Berlot
authors.affiliation: Service d'Hépato-Gastroentérologie, CHIC de Créteil, 40 avenue de Verdun, 94010 Créteil cedex, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Rosa
authors.affiliation: Service d'Hépato-Gastroentérologie, centre hospitalier, 135 rue du Président Coty, 59 200 Tourcoing, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Talbodec
authors.affiliation: Inserm U-1075, Service d'Hépato-Gastroentérologie, hôpital de Caen, avenue de la Côte de Nacre, 14000 Caen, France.
authors.forename: Thong
authors.initials: T
authors.lastname: Dao
authors.affiliation: Service d'Hépato-Gastroentérologie, hôpital Lariboisière, 2 rue Ambroise-Paré, 75010 Paris, France.
authors.forename: Violaine
authors.initials: V
authors.lastname: Ozenne
authors.affiliation: Service d'Hépato-Gastroentérologie, hôpital Saint-Antoine, 184 rue du Fbg St Antoine, 75571 Paris cedex 12, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Carbonell
authors.affiliation: Service d'Hépato-Gastroentérologie, hôpital de la Source, BP 6709, 45067 Orléans cedex 12, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Causse
authors.affiliation: Service d'Hépato-Gastroentérologie, hôpital de Rouen, 1 Rue Germont, 76000 Rouen, France.
authors.forename: Odile
authors.initials: O
authors.lastname: Goria
authors.affiliation: Service d'Hépato-Gastroentérologie, hôpital du Bocage, BP 1542, 21034 Dijon cedex, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Minello
authors.affiliation: Service d'Hépato-Gastroentérologie, hôpital du haut Levêque, 33604 Pessac cedex, France.
authors.forename: Victor
authors.initials: V
authors.lastname: De Ledinghen
authors.affiliation: Service d'Hépato-Gastroentérologie, hôpital Jean Verdier, av. du 14 juillet, 93143 Bondy cedex, France.
authors.forename: Roland
authors.initials: R
authors.lastname: Amathieu
authors.affiliation: Service d'Hépato-Gastroentérologie, hôpital de Brabois, rue du Morvan, 54511 Vandoeuvre-les-Nancy cedex, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Barraud
authors.affiliation: Service d'Hépato-Gastroentérologie, hôpital d'Amiens, 2 Place Victor Pauchet, 80080 Amiens, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Nguyen-Khac
authors.affiliation: Service d'Hépato-Gastroentérologie, hôpital de Lens, 99 route de la Bassée, SP-8, 62307 Lens cedex, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Becker
authors.affiliation: Service d'Hépato-Gastroentérologie, hôpital de Dunkerque, 130 avenue Louis Herbeaux, 59385 Dunkerque cedex 1, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Paupard
authors.affiliation: Service d'Hépato-Gastroentérologie, hôpital de la Conception, 147 Bd Baille, 13005 Marseille, France.
authors.forename: Danielle
authors.initials: D
authors.lastname: Botta-Fridlung
authors.affiliation: Service d'Hépato-Gastroentérologie, hôpital de Chalons-en-Champagne, 51 rue du commandant Derrien, 51005 Chalons-en-Champagne cedex, France.
authors.forename: Naceur
authors.initials: N
authors.lastname: Abdelli
authors.affiliation: Service d'Hépato-Gastroentérologie, hôpital de Roubaix, 11-17 Boulevard Lacordaire, 59100 Roubaix, France.
authors.forename: François
authors.initials: F
authors.lastname: Guillemot
authors.affiliation: Service d'Hépatologie, hôpital Jean Minjoz, 25000 Besançon, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Monnet
authors.affiliation: Service d'Hépatologie, hôpital Jean Minjoz, 25000 Besançon, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Di Martino
mesh_terms: D000328:Adult; D000418:Albumins / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000188:drug therapy / Q000209:etiology; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007677:Kidney Function Tests / Q000379:methods; D008103:Liver Cirrhosis / Q000150:complications*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D018805:Sepsis / Q000188:drug therapy / Q000209:etiology; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000418:Albumins; D000900:Anti-Bacterial Agents
keywords: Liver cirrhosis; Portal hypertension; Prognosis; Renal failure; Sepsis