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Previous Volume 341:403-409 August 5, 1999 Number 6 Next

	Full Text PDF Editorial by Bass, N. M. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background In patients with cirrhosis and spontaneous bacterial peritonitis, renal function frequently becomes impaired. This impairment is probably related to a reduction in effective arterial blood volume and is associated with a high mortality rate. We conducted a study to determine whether plasma volume expansion with intravenous albumin prevents renal impairment and reduces mortality in these patients.

Methods We randomly assigned 126 patients with cirrhosis and spontaneous bacterial peritonitis to treatment with intravenous cefotaxime (63 patients) or cefotaxime and intravenous albumin (63 patients). Cefotaxime was given daily in doses that varied according to the serum creatinine level, and albumin was given at a dose of 1.5 g per kilogram of body weight at the time of diagnosis, followed by 1 g per kilogram on day 3. Renal impairment was defined as nonreversible deterioration of renal function during hospitalization.

Results The infection resolved in 59 patients in the cefotaxime group (94 percent) and 62 in the cefotaxime-plus-albumin group (98 percent) (P=0.36). Renal impairment developed in 21 patients in the cefotaxime group (33 percent) and 6 in the cefotaxime-plus-albumin group (10 percent) (P=0.002). Eighteen patients (29 percent) in the cefotaxime group died in the hospital, as compared with 6 (10 percent) in the cefotaxime-plus-albumin group (P=0.01); at three months, the mortality rates were 41 percent (a total of 26 deaths) and 22 percent (a total of 14 deaths), respectively (P=0.03). Patients treated with cefotaxime had higher levels of plasma renin activity than those treated with cefotaxime and albumin; patients with renal impairment had the highest values.

Conclusions 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.

Source Information

From the Liver Unit, Institut de Malalties Digestives, Hospital Clínic, and Institut d'Investigacions Biomèdiques August Pi-Sunyer, Barcelona (P.S., M.N., V.A., M.G., P.G., J.R.); the Gastroenterology Unit, Hospital Germans Trias i Pujol, Badalona (X.A., R.P.); the Gastroenterology Unit, Hospital Ramón y Cajal, Madrid (L.R.A.); the Liver Unit, Hospital Vall d'Hebron, Barcelona (L.C., V.V.); and the Gastroenterology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona (G.S.) — all in Spain.

Address reprint requests to Dr. Arroyo at the Liver Unit, Institut de Malalties Digestives, Hospital Clínic, Villarroel 170, 08036 Barcelona, Catalunya, Spain, or at arroyo{at}medicina.ub.es.

Full Text of this Article

Related Letters:

Intravenous Albumin in Patients with Cirrhosis and Spontaneous Bacterial Peritonitis
Patch D., Burroughs A., Sort P., Ginès P., Arroyo V.
Extract | Full Text  
N Engl J Med 1999; 341:1773-1774, Dec 2, 1999. Correspondence

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