The benefits of using albumin in the treatment of patients with cirrhosis and bacterial infections
The use of albumin in combination with antibiotic therapy may improve the outcome of spontaneous bacterial infections in patients with cirrhosis.
According to a study conducted in Spain, the use of albumin improves renal function and microcirculation in patients with cirrhosis in the presence of infections, with the exception of spontaneous bacterial peritonitis (SBP).
It should be noted that the efficacy of albumin in increasing the survival rate was low, however, such a statement should be based on the results of large studies conducted in various clinical settings before recommending its use as a standard for the treatment of these conditions.
Previous studies have shown that administering albumin to patients with cirrhosis in the presence of SBP can prevent adverse effects on microcirculation and the development of kidney failure, as well as increasing life expectancy.. As a result, the recommendations suggest the use of albumin in these patients.
In a study of 110 patients with cirrhosis, the appointment of albumin also increases life expectancy and protects blood vessels and the kidneys from damage in the presence of infections other than SBP.
Blood creatinine levels were lower during the 14 days of the study in patients randomly selected with albumin in combination with antibiotics compared to patients who received antibiotics only. In addition, statistically significant differences in creatinine levels were only determined on the 3rd and 7th day.
In 20 of 97 patients, renal impairment was detected before inclusion in the study (10 in each group). In the group of patients receiving albumin, renal failure was reversible, while in the control group, only 6 patients showed similar dynamics.
Among 77 patients who had normal renal function at the time of inclusion, 4 (10%) in the control group and 1 (3%) in the albumin group developed renal impairment (the differences between the groups were not statistically significant).
Levels of plasma renin, plasma aldosterone, and norepinephrine activity decreased significantly in the albumin group, while levels of atrial natriuretic plasma hormone increased, which contributed to an increase in effective volume. circulating blood.
Mean arterial pressure decreased significantly on day 7 from baseline in the control group, but remained the same in the albumin group.
At the end of the observation period, which lasted 3 months, 10 patients in the control group and 8 in the albumin group died, with no significant difference in the survival rate in the two groups without corresponding corrections.
The three-month mortality rate was significantly higher in patients with renal impairment than in patients with normal renal function (56% versus 19%, p less than 0.001). After adjusting for possible distortion factors, it was found that the appointment of albumin can increase the number of surviving patients (p = 0.04).
Thus, the scientists concluded that the prevention of kidney failure is one of the main factors in reducing mortality in patients with cirrhosis.