Albumin in SBP
Albumin Infusion Improves Outcomes of Patients With Spontaneous Bacterial Peritonitis: A Meta-analysis of Randomized Trials. F. Salerno et al. Clinical Gastroenterology and Hepatology 2013;11:123-130.
A meta-analysis of RCTs evaluating the benefit of albumin administration on renal function and mortality in patients with SBP.
A meta-analysis was preformed to strengthen the support for the use of 20% albumin in patients with diagnosed SBP. Three investigators searched both published and unpublished literature for randomized trials that studied albumin use in SBP, and were able to identify 4 RCTs, totally 288 patients. There was no significant heterogeneity between trials. The studies did vary in regards to albumin dosing and slightly with timing of albumin administration, although the treatment regimens all involved albumin at time of diagnosis and a course of at least 3 days. The primary outcomes evaluated were renal impairment and in-hospital mortality.
Both renal impairment and mortality were reduced in the albumin recipient group as compared to the control group. The odds ratio for renal impairment was 0.21 (CI 0.11-0.42), while odds ratio for mortality was 0.34 (CI 0.19-0.60).
Administration of 20% albumin at time of SPB diagnosis can significantly reduce acute renal failure and mortality and is a treatment that can be initiated in the ED. At this time, the precise dosage and timing schedule of albumin has not been determined, but it appears that an initial dose of 1-1.5 g/kg given within the first 6 hours of diagnosis is effective.