Albumin Infusion Cuts Renal Impairment and Mortality Risk in Patients with Spontaneous Bacterial Peritonitis

Noting that albumin administration has been reported to reduce renal impairment and mortality in patients with spontaneous bacterial peritonitis (SBP), U.S. and Italian investigators performed a meta-analysis of randomized controlled trials to quantify this effect. A total of four trials involving 288 patients were identified and included in the analysis.

Albumin was compared with no albumin in three trials and with an artificial colloid in the fourth trial. No evidence of statistically significant heterogeneity or publication bias was found in any of these studies. The incidence of renal impairment was 44 of 144 (30.6%) in control group subjects, compared with 12 of 144 (8.3%) in groups given albumin. The pooled odds ratio for renal impairment after albumin therapy was 0.21 (95% confidence interval [CI], 0.11 to 0.42).

Control group mortality was 51 of 144 (35.4%), compared with 23 of 144 (16.0%) among patients who received albumin. The pooled odds ratio for decreased mortality after albumin infusion was 0.34 (95% CI, 0.19 to 0.60). “Based on our quantitative findings and the clear benefits demonstrated, it seems prudent to treat all SBP patients with albumin, regardless of whether they are high-risk or low-risk for poor outcome,” the study’s lead author said.