Albumin in Spontaneous Bacterial Peritonitis

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July 4, 2017 by Casey Carr

By: Binoy Mistry


Background:

Mortality in spontaneous bacterial peritonitis ranges from 20-40%; renal impairment can occur up to 40% of cases. Albumin infusions are thought to bind endotoxins and nitric oxide, as well as help to increase intravascular volume, leading to decreased renal impairment and mortality.


Evidence:

2013 systemic review (Salerno et al) found that in patient’s diagnosed with SBP (>250/mm3 WBC in ascitic fluid) albumin infusion within 6 hours decreased rates of renal impairment (30.6% vs 8.3%) and mortality (35.4% vs 16%). NNT to prevent one death = 6, NNT to prevent one case of renal failure = 4.


Dosing:

0.5-1.5 g/kg of 20% solution within 6 hours.


References:

Salerno F, Navickis RJ, Wilkes MM. Albumin infusion improves outcomes of patients with spontaneous bacterial peritonitis: a meta-analysis of randomized trials. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 11(2):123-30.e1. 2013.

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