Dipartimento di Medicina Interna, Università degli Studi di Milano, Policlinico IRCCS San Donato, Milano, Italy.
Clin Gastroenterol Hepatol. 2013 Feb;11(2):123-30.e1. doi: 10.1016/j.cgh.2012.11.007. Epub 2012 Nov 22.
BACKGROUND & AIMS: Renal impairment increases mortality among patients with spontaneous bacterial peritonitis (SBP), despite administration of non-nephrotoxic antibiotics. Albumin infusion has been reported to reduce renal impairment and mortality in patients with SBP. We performed a meta-analysis of randomized controlled trials (RCTs) to quantify the effect of albumin infusion on renal impairment and mortality in patients with SBP.
We searched MEDLINE, EMBASE, the Cochrane Library, and ClinicalTrials.gov for RCTs that evaluated albumin treatment for patients with SBP; we also performed searches by additional methods. Four trials of 288 total patients were included in our analysis. Data were quantitatively combined under a fixed-effects model.
We found no evidence of statistically significant heterogeneity or publication bias among the studies analyzed. Albumin was compared with no albumin in 3 trials and with artificial colloid in 1 trial. All patients received antibiotics. The incidence of renal impairment in control groups was 44 of 144 (30.6%), compared with 12 of 144 (8.3%) in groups given albumin. The pooled odds ratio for a reduction in renal impairment after albumin infusion was 0.21 (95% confidence interval, 0.11-0.42). Odds ratios for renal impairment after albumin therapy ranged from 0.19-0.30 among the individual studies. Mortality among controls 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 infusion of albumin was 0.34 (95% confidence interval, 0.19-0.60). Odds ratios for mortality in individual RCTs ranged from 0.16-0.55.
In a meta-analysis of 4 RCTs (288 patients), albumin infusion prevented renal impairment and reduced mortality among patients with SBP.
尽管使用了非肾毒性抗生素，肾功能损害仍会增加自发性细菌性腹膜炎（SBP）患者的死亡率。已有报道称白蛋白输注可减少 SBP 患者的肾功能损害和死亡率。我们对随机对照试验（RCT）进行了荟萃分析，以量化白蛋白输注对 SBP 患者肾功能损害和死亡率的影响。
我们检索了 MEDLINE、EMBASE、Cochrane 图书馆和 ClinicalTrials.gov，以评估白蛋白治疗 SBP 患者的 RCT；我们还通过其他方法进行了搜索。我们的分析纳入了 4 项共 288 名患者的 RCT。数据在固定效应模型下进行定量合并。
我们未发现分析中的研究存在统计学显著异质性或发表偏倚。白蛋白与 3 项试验中的无白蛋白进行了比较，与 1 项试验中的人工胶体进行了比较。所有患者均接受了抗生素治疗。对照组肾功能损害的发生率为 144 例中的 44 例（30.6%），而给予白蛋白组为 144 例中的 12 例（8.3%）。白蛋白输注后肾功能损害减少的合并优势比为 0.21（95%置信区间，0.11-0.42）。个别研究中白蛋白治疗后肾功能损害的优势比范围为 0.19-0.30。对照组的死亡率为 144 例中的 51 例（35.4%），而接受白蛋白组为 144 例中的 23 例（16.0%）。白蛋白输注后死亡率降低的合并优势比为 0.34（95%置信区间，0.19-0.60）。个别 RCT 中死亡率的优势比范围为 0.16-0.55。
在对 4 项 RCT（288 名患者）的荟萃分析中，白蛋白输注可预防 SBP 患者的肾功能损害并降低死亡率。
