Albumin Reduces Paracentesis-Induced Circulatory Dysfunction and Reduces Death and Renal Impairment among Patients with Cirrhosis and Infection: A Systematic Review and Meta-Analysis

Article, Review English OPEN
Kwok, Chun Shing ; Krupa, Lukasz ; Mahtani, Ash ; Kaye, Duncan ; Rushbrook, Simon M. ; Phillips, Martin G. ; Gelson, William (2013)
  • Publisher: Hindawi Publishing Corporation
  • Journal: BioMed Research International, volume 2,013 (issn: 2314-6133, eissn: 2314-6141)
  • Related identifiers: doi: 10.1155/2013/295153, pmc: PMC3816020
  • Subject: Review Article | Article Subject | R1

Background. Studies have suggested that albumin has a value in cirrhotic patients undergoing paracentesis but its value in infection and sepsis is less clear. We planned to perform a meta-analysis of the risk of adverse outcomes in cirrhotic patients with and without albumin use. Methods. We searched MEDLINE and EMBASE in January 2013 for randomized studies of cirrhotic patients that reported the risk of adverse events and mortality with albumin and no albumin exposure. We performed random effects meta-analysis and assessed heterogeneity using the I2 statistic. Results. Our review included 16 studies covering 1,518 patients. The use of albumin in paracentesis was associated with significantly reduced risk of paracentesis-induced circulatory dysfunction (OR 0.26 95%, CI 0.08–0.93) and there was a nonsignificant difference in death, encephalopathy, hyponatraemia, readmission, and renal impairment. Compared to the other volume expanders, albumin use showed no difference in clinical outcomes. In cirrhotic patients with any infection, there was a significant reduction in mortality (OR 0.46 95%, CI 0.25–0.86) and renal impairment (OR 0.34 95%, CI 0.15–0.75) when albumin was used. Conclusion. The use of albumin in cirrhotic patients is valuable in patients with any infection and it reduces the risk of circulatory dysfunction among patients undergoing paracentesis.
  • References (37)
    37 references, page 1 of 4

    [1] L. Ruiz-Del-Arbol, A. Monescillo, W. Jimenez, A. Garcia-Plaza, V. Arroyo, and J. Rodes, “Paracentesis-induced circulatory dysfunction: mechanism and eefct on hepatic hemodynamics in cirrhosis,” Gastroenterology, vol. 113, no. 2, pp. 579-586, 1997.

    [2] P. Gines, L. Tito, V. Arroyo et al., “Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis,” Gastroenterology, vol. 94, no. 6, pp. 1493- 1502, 1988.

    [3] P. Gine`s and A. Ca´rdenas, “eTh management of ascites and hyponatremia in cirrhosis,” Seminars in Liver Disease, vol. 28, no. 1, pp. 43-58, 2008.

    [4] F. Salerno, M. Guevara, M. Bernardi et al., “Refractory ascites: pathogenesis, definition and therapy of a severe complication in patients with cirrhosis,” Liver International, vol. 30, no. 7, pp. 937-947, 2010.

    [5] B. A. Runyon, “Management of adult patients with ascites due to cirrhosis: update 2012,” AASLD Practice Guidelines.

    [6] P. Gine`s, P. Angeli, K. Lenz et al., “EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis,” Journal of Hepatology, vol. 53, no. 3, pp. 397-417, 2010.

    [7] J. Ferna´ndez, M. Navasa, J. C. Garcia-Pagan et al., “Eefct of intravenous albumin on systemic and hepatic hemodynamics and vasoactive neurohormonal systems in patients with cirrhosis and spontaneous bacterial peritonitis,” Journal of Hepatology, vol. 41, no. 3, pp. 384-390, 2004.

    [8] P. Sort, M. Navasa, V. Arroyo et al., “Eefct of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis,” eTh New England Journal of Medicine, vol. 341, no. 6, pp. 403-409, 1999.

    [9] J. Ferna´ndez, M. Navasa, J. Go´mez et al., “Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and noroflxacin prophylaxis,” Hepatology, vol. 35, no. 1, pp. 140- 148, 2002.

    [10] F. Wong, M. Bernardi, R. Balk et al., “Sepsis in cirrhosis: report on the 7th meeting of the International Ascites Club,” Gut, vol. 54, no. 5, pp. 718-725, 2005.

  • Metrics
    No metrics available
Share - Bookmark