Sort P. NEJM 1999; 341(6): 403-9.
RESULTS
Randomization: 199 consecutive patients with cirrhosis who had spontaneous bacterial peritonitis, 73 excluded, 126 randomized.
Baseline: Average age 62y, 30% had alcoholic cirrhosis, 11% had hepatocellular carcinoma, average Child-Pugh score was 10.2, 44% had renal failure, 65% on diuretic therapy, 57% had isolated organism, most being E. coli.
Outcomes:
Resolution of infection: 98 vs 94%, p = 0.36
Renal impairment: 10 vs 33%, ARR 23%, NNT 4.3, p = 0.002
Death, in hospital: 10 vs 29%, ARR 19%, NNT 5.3, p = 0.01
Death, at three months: 22 vs 41%, ARR 19%, NNT 5.3, p = 0.03
Adverse Events: no reported adverse events
Discussion: Cost of albumin is between $5 and $25 per gram in the US. For the average 70kg man, this would cost between $875 to $4,375 per patient, and $4,375 to $23,200 to save one life. Mortality rates from SBP have been steadily decreasing over the last 15 years, this serves as another tool for prevention of hepatorenal syndrome and death.
Recent IC Attempts