人血白蛋白输注在没有急性肾损伤和自发性细菌性腹膜炎的患者中也是安全有效的。
Human albumin infusion is safe and effective even in patients without acute kidney injury and spontaneous bacterial peritonitis.
机构信息
Department of Hepatology, AIG Hospitals, Hyderabad, 500 032, India.
Department of Clinical Pharmacy, AIG Hospitals, Hyderabad, 500 032, India.
出版信息
Indian J Gastroenterol. 2024 Apr;43(2):485-493. doi: 10.1007/s12664-023-01475-0. Epub 2023 Dec 12.
BACKGROUND AND OBJECTIVES
Human albumin (HA) solution is currently recommended only for patients with spontaneous bacterial peritonitis (SBP) and acute kidney injury (AKI). However, its use in hospitalized patients is quite frequent. The objective was to compare the outcomes of patients receiving HA in recommended (Gr. A) vs. non-recommended (Gr. B) indications.
METHODS
In this prospective study, consecutive hospitalized patients who received HA were included. Apart from comparing the proportion of patients achieving resolution of hyponatremia, infection and hepatic encephalopathy among Gr. A and Gr. B, we also compared the in-hospital survival and performed a sub-group analysis of patients with the European Association for the Study of the Liver (EASL) acute-on-chronic liver failure (ACLF) and decompensated cirrhosis (DC).
RESULTS
Of the 396 hospitalized patients who received HA, 180 had AKI and/or SBP (Gr. A), and 216 received albumin for non-recommended indications (Gr. B). The mean age, sex and etiology distribution were similar. The total dose of HA was higher (88 ± 61.62 g vs. 71.31 ± 488.17 g; p = 0.003) and the duration longer (4 ± 2.37 vs. 3.4 ± 1.82 days; p = 0.005) in Gr. A than B. The resolution of infection and HE was similar among both groups, while hyponatremia resolution was significantly higher in Gr. B (94.7%) than Gr. A (75.6%; p < 0.001). On Kaplan-Meier analysis, survival was significantly higher in Gr. B (94%) than Gr. A (78.9%; p < 0.001). The incidence of albumin-induced fluid overload was comparable (2.8% vs. 1.4%; p = 0.32). Patients with ACLF were sicker with a higher incidence of microbiologically proven infection, hepatic encephalopathy (HE) and hyponatremia than in the DC group. Resolution of infection and hyponatremia and in-hospital survival was significantly lower in the ACLF group (72.5%) than in the DC group (92.7%; p < 0.001). Eighty-six per cent of patients achieved resolution of ACLF.
CONCLUSIONS
HA infusion is safe and effective even in patients without AKI and SBP and leads to the resolution of infection, hyponatremia, HE and ACLF.
背景和目的
目前，人血白蛋白（HA）溶液仅推荐用于自发性细菌性腹膜炎（SBP）和急性肾损伤（AKI）患者。然而，它在住院患者中的使用相当频繁。本研究的目的是比较在推荐（A 组）和非推荐（B 组）适应证下接受 HA 治疗的患者的结局。
方法
在这项前瞻性研究中，纳入了接受 HA 治疗的连续住院患者。除了比较 A 组和 B 组患者低钠血症、感染和肝性脑病缓解的比例外，我们还比较了住院期间的生存率，并对欧洲肝脏研究协会（EASL）急性失代偿性慢性肝衰竭（ACLF）和失代偿性肝硬化（DC）患者进行了亚组分析。
结果
在 396 名接受 HA 治疗的住院患者中，180 名患者患有 AKI 和/或 SBP（A 组），216 名患者因非适应证接受白蛋白治疗（B 组）。两组患者的平均年龄、性别和病因分布相似。A 组患者的 HA 总剂量较高（88±61.62g 比 71.31±488.17g；p=0.003），使用时间较长（4±2.37 天比 3.4±1.82 天；p=0.005）。两组患者的感染和 HE 缓解情况相似，而 B 组患者低钠血症缓解率显著高于 A 组（94.7%比 75.6%；p<0.001）。在 Kaplan-Meier 分析中，B 组患者的生存率显著高于 A 组（94%比 78.9%；p<0.001）。白蛋白诱导的液体超负荷发生率相当（2.8%比 1.4%；p=0.32）。ACLF 患者的病情更严重，微生物证实感染、肝性脑病（HE）和低钠血症的发生率高于 DC 组。感染和低钠血症的缓解以及住院期间的生存率在 ACLF 组显著低于 DC 组（72.5%比 92.7%；p<0.001）。86%的 ACLF 患者得到缓解。
结论
即使在没有 AKI 和 SBP 的患者中，输注 HA 也是安全有效的，可导致感染、低钠血症、HE 和 ACLF 的缓解。
Zotero 插件