KING OF PRUSSIA, Pa., Jan. 21, 2013 /PRNewswire/ -- Treatment with albumin reduces renal impairment and mortality in cirrhotic patients with spontaneous bacterial peritonitis (SBP), one of the most common bacterial infections in this patient population, according to a new meta-analysis supported by CSL Behring and published today in Clinical Gastroenterology and Hepatology, the official clinical practice journal of the American Gastroenterological Association Institute. Albumin, a natural plasma-derived protein that expands blood plasma volume, is widely used in conjunction with large-volume paracentesis to treat tense ascites, with vasoconstrictors for type 1 hepatorenal syndrome and with antibiotics for SBP.
"While current clinical guidelines indicate the benefits of albumin for patients with SBP, questions regarding patient selection and albumin dosing in the management of the condition still linger," said Francesco Salerno, M.D., Professor of Internal Medicine at the University of Milan in Italy, and lead author of the meta-analysis. "Based on our quantitative findings and the clear benefits demonstrated, it seems prudent to treat all SBP patients with albumin, regardless of whether they are high-risk or low-risk for poor outcome."
SBP occurs without any obvious source of intra-abdominal infection. Several factors are believed to contribute to SBP including bacterial overgrowth in the intestine, passage of the bacteria across an impaired intestinal barrier into the blood stream and abdominal cavity, and a deficient local immune response to the invasion. Renal impairment, a frequent complication of SBP, is associated with high risk of mortality, which may reach 30% despite prompt treatment.
The meta-analysis, which included results from four randomized controlled trials with 288 total patients, found that SBP patients treated with albumin were less likely to develop renal impairment (8.3 percent in the albumin-treated groups versus 30.6 percent in the control groups). The odds ratios for renal impairment in the four trials were highly consistent, ranging from 0.19 to 0.30. The analysis also found that mortality was decreased with albumin administration (16 percent in the albumin-treated groups versus 35.4 percent in the control groups). Odds ratios for mortality were also similar, ranging from 0.16 to 0.55.