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Article dans une revue

Effect of albumin in cirrhotic patients with infection other than spontaneous bacterial peritonitis. A randomized trial

Thong Dao 1 Violaine Ozenne 2 Nicolas Carbonell 3 Xavier Causse 4 Odile Goria 5 Anne Minello 6 Victor de Ledinghen 7 Roland Amathieu 8 Helene Barraud 9 Eric Nguyen-Khac 10 Claire Becker 11 Thierry Paupard 12 Danielle Botta-Fridlung Naceur Abdelli François Guillemot 13 Elisabeth Monnet 14, 15 Vincent Di Martino 16 Thierry Thevenot 6 Christophe Bureau 17 Frédéric Oberti 18 Rodolphe Anty 19, 20 Alexandre Louvet 21 Aurélie Plessier 22 Marika Rudler 23 Alexandra Heurgue-Berlot 24 Isabelle Rosa 25 Nathalie Talbodec
Abstract :

BACKGROUND & AIMS: 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.

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https://hal.univ-angers.fr/hal-02648805
Contributeur : Okina Université d'Angers <>
Soumis le : vendredi 29 mai 2020 - 10:29:17
Dernière modification le : mercredi 14 octobre 2020 - 04:16:57

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Thong Dao, Violaine Ozenne, Nicolas Carbonell, Xavier Causse, Odile Goria, et al.. Effect of albumin in cirrhotic patients with infection other than spontaneous bacterial peritonitis. A randomized trial. Journal of Hepatology, Elsevier, 2015, 62 (4), pp.822-30. ⟨10.1016/j.jhep.2014.11.017⟩. ⟨hal-02648805⟩

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