Department of Gastroenterology and Hepatology, Changi General Hospital.
Education Resource Centre, Singapore General Hospital, Department of Medicine.
Dig Liver Dis. 2020 Oct;52(10):1137-1142. doi: 10.1016/j.dld.2020.05.047. Epub 2020 Jun 23.
Efficacy and Safety of intravenous albumin for non-spontaneous bacterial peritonitis infection among patients with cirrhosis: A systematic review and meta-analysis of randomized controlled trials INTRODUCTION: Bacterial infection is a common cause of acute-on-chronic liver failure (ACLF) and death among cirrhosis. The benefit of intravenous (IV) albumin among cirrhosis with non-SBP infection remains unclear as individual studies are underpowered to detect the survival benefit of IV albumin.
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of intravenous albumin for non-SBP infection among cirrhosis patients.
We performed a systematic search of electronic databases (Pubmed, MEDLINE and Clinicalkey) up to 1 December 2019. Studies evaluating IV albumin for non-SBP infection were selected. Using random effect model, the pooled odds ratio (OR), 95% confidence interval (95%CI) and heterogeneity were assessed.
A total of 3 RCTs (406 subjects) fulfilling the inclusion criteria among 218 citations were identified. There was no significant heterogeneity across included studies. In this meta-analysis, we found that the pooled risk of renal impairment (RI) (OR=0.58, 95%CI: 0.28-1.23, I=0%), mortality at 30 days (OR=1.61, 95%CI: 0.87-3.00, I=0%) as well as mortality at 90 days (OR=1.30, 95%CI: 0.81-2.07, I=0%) were similar between albumin and control group. Pooled event of pulmonary edema occurred more commonly in albumin group (OR 5.17, 95%CI 1.62-16.47, I=0%). More subjects achieved resolution of ACLF in IV albumin group as compared to control group (OR=0.11, 95%CI: 0.02-0.69, p=0.02).
Albumin did not reduce the risk of RI and mortality, yet increases the risk of pulmonary edema. Albumin may promote recovery of ACLF, however, more data is required to validate this benefit.
我们对随机对照试验（RCT）进行了系统评价和荟萃分析，以评估肝硬化患者非 SBP 感染时静脉注射白蛋白的疗效和安全性。
我们对电子数据库（Pubmed、MEDLINE 和 Clinicalkey）进行了系统检索，检索时间截至 2019 年 12 月 1 日。选择评估非 SBP 感染时静脉注射白蛋白的研究。使用随机效应模型，评估汇总优势比（OR）、95%置信区间（95%CI）和异质性。
共纳入 3 项 RCT（406 例患者），排除了 218 篇参考文献中的 218 篇。纳入研究之间无显著异质性。在这项荟萃分析中，我们发现，在肾功能不全（RI）风险方面（OR=0.58，95%CI：0.28-1.23，I=0%）、30 天死亡率（OR=1.61，95%CI：0.87-3.00，I=0%）以及 90 天死亡率（OR=1.30，95%CI：0.81-2.07，I=0%）方面，白蛋白组和对照组相似。白蛋白组肺水肿的发生率更高（OR 5.17，95%CI 1.62-16.47，I=0%）。与对照组相比，静脉注射白蛋白组更常见 ACLF 缓解（OR=0.11，95%CI：0.02-0.69，p=0.02）。
白蛋白不能降低 RI 和死亡率的风险，但会增加肺水肿的风险。白蛋白可能促进 ACLF 的恢复，但需要更多的数据来验证这一益处。
