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Renal impairment was a non-reversible deterioration of renal function during hospitalization. Potential causes of dehydration within 1 week before the diagnosis of peritonitis (diarrhea or an intense response to diuretics) or known CVP 30 mg/dL (11 mmol/L) or creatinine >1.5 mg/dL.Any disease affecting short-term prognosis (e.g., advanced neoplasia).Evidence of nephropathy: Proteinuria, hematuria, or abnormal renal ultrasound.Grade 3 or 4 hepatic encephalopathy (Conn and Lieberthal scale).Treatment with antibiotics at time of diagnosis.No antibiotic treatment in the week prior to SBP diagnosis, except norfloxacin prophylaxis.PMN cell count in the ascitic fluid > 250 mm 3 in the absence of findings suggestive of secondary peritonitis.The WJC editors are considering renal impairment, hospital mortality, and 90 day all-cause mortality as the primary outcomes. Settling: 7 university hospitals in Spain.
#Spb wiki trial#
Multi-center, open-label (analyst-blinded), randomised controlled trial.If there is a suspicion of SBP and PMNs are >250 cells/mm 3, check ascitic proteini, LDH, glucose, Gram's stain, CEA, and alk phos to help differentiate it from secondary peritonitis.This letter reported that none of the 15 low-risk patients (bilirubin 250 cells/mm 3 (0.25 x 10 9/L) and clinical suspicion of SBP and either a serum creatinine >1 mg/dL, blood urea nitrogen >30 mg/dL, or total bilirubin >4 mg/dL should receive 1.5 g albumin per kg body weight within 6 hours of presentation and 1 g/kg on day 3. Included in this meta-analysis was a 2007 retrospective study by Sigal and colleagues published as a letter in in GUT. Albumin administration was associated with a pooled odds ratio of 0.21 (95% CI 0.11-0.42) for renal impairment and 0.34 (95% CI 0.19-0.60) for mortality, supporting the practice of albumin infusion among adults with cirrhosis and SBP. 41% P=0.03).Ī 2013 meta-analysis of 4 studies with 288 patients was performed to determine the effects of albumin infusion on renal impairment and mortality rates among patients with SBP. 29% P=0.01), and all-cause mortality at 3 months (22% vs. However, the cefotaxime+albumin group had a lower incidence of renal impairment (10% vs. Resolution of infection was similar in both treatment groups (P=0.36). Published in 1999 by Sort and colleagues, this study randomized 126 patients with cirrhosis and SBP to cefotaxime alone or cefotaxime and intravenous albumin. Albumin increases oncotic pressure over the short term and its administration may improve renal perfusion, renal outcomes, and mortality among those with SBP. As individuals with cirrhosis have a low baseline oncotic pressure, renal perfusion is reduced, leading to renal insufficiency. The underlying mechanism of SBP's harm are thought to be related to a decrease in effective arterial blood volume from the infection. While antibiotics mitigate some harm, SBP survivors experience a high incidence of renal dysfunction.
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Spontaneous bacterial peritonitis (SBP) is a common infection associated with cirrhosis that carries significant morbidity and mortality. Among patients with cirrhosis and spontaneous bacterial peritonitis treated with antibiotics, does intravenous albumin reduce incident renal impairment and mortality when compared to antibiotics alone?Īmong patients with cirrhosis and spontaneous bacterial peritonitis on IV antibiotics, IV albumin reduces the incidence of renal impairment and mortality when compared to antibiotics alone.