Gastroenterology in critical care · Albumin in spontaneous bacterial peritonitis
Effect of intravenous albumin on renal impairment and mortality in cirrhosis and spontaneous bacterial peritonitis
| Design | Randomised controlled trial |
|---|---|
| Treatment | Cefotaxime plus intravenous albumin 1.5 g/kg at diagnosis, then 1 g/kg on day 3 |
| Control | Cefotaxime alone |
| Population | 126 patients with cirrhosis and spontaneous bacterial peritonitis |
| Follow-up | 3 months |
| Primary endpoint | Renal impairment and mortality |
| Result | Infection resolved in 59 of 63 (94%) with cefotaxime and 62 of 63 (98%) with cefotaxime plus albumin (p=0.36). Renal impairment developed in 21 (33%) versus 6 (10%), p=0.002. In-hospital mortality was 29% versus 10% (p=0.01) and three-month mortality 41% versus 22% (p=0.03). |
| Secondary endpoints | In-hospital mortality, three-month mortality, resolution of infection |
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.
The trial authors, in the published abstract
Standard care ever since, and one of the clearest indications for albumin anywhere in medicine — a striking exception in a fluid whose broader use has repeatedly failed to show benefit.
Sort P, Navasa M, Arroyo V, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med 1999 Aug 5;341(6):403-9.