Service d'Hépatologie, hôpital Jean Minjoz, 25000 Besançon, France.
Service d'Hépato-Gastroentérologie, hôpital Purpan, clinique Dieulafoy, 31059 Toulouse, France.
J Hepatol. 2015 Apr;62(4):822-30. doi: 10.1016/j.jhep.2014.11.017. Epub 2014 Nov 21.
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.
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.
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.
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.
白蛋白输注可改善自发性细菌性腹膜炎（SBP）以外的肝硬化合并菌血症患者的肾功能和存活率，但在其他类型感染中的疗效尚不清楚。我们通过一项多中心随机对照试验对此进行了研究。
共纳入 193 例 Child-Pugh 评分>8 分且与 SBP 无关的败血症肝硬化患者，随机分为接受抗生素联合白蛋白（第 1 天 1.5g/kg，第 3 天 1g/kg；白蛋白组 [ALB]：n=96）或单独接受抗生素（对照组 [CG]：n=97）治疗。主要终点为 3 个月肾功能衰竭发生率（肌酐升高 ⩾50%，最终值 ⩾133 μmol/L）。次要终点为 3 个月生存率。
47 例（24.6%）患者死亡（ALB：n=27 例 vs. CG：n=20 例；3 个月生存率：70.2% vs. 78.3%；p=0.16）。白蛋白输注延迟了肾功能衰竭的发生（平均发病时间，ALB：29.0 ± 21.8 天 vs. CG：11.7 ± 9.1 天，p=0.018），但 3 个月肾功能衰竭发生率相似（ALB：14.3% vs. CG：13.5%；p=0.88）。多因素分析显示，MELD 评分（p<0.0001）、肺炎（p=0.0041）、低钠血症（p=0.031）和肾功能衰竭的发生（p<0.0001）是死亡的预测因素。值得注意的是，白蛋白组有 8/96（8.3%）例患者出现肺水肿，其中 2 例在白蛋白输注当天和第 33 天死亡。
在非 SBP 感染的肝硬化患者中，白蛋白输注延迟了肾功能衰竭的发生，但不能改善 3 个月时的肾功能和生存率。大量白蛋白输注应谨慎用于病情最严重的肝硬化患者。
