Albumin infusion in patients undergoing large-volume paracentesis: A meta-analysis of randomized trials

Albumin infusion reduces the incidence of postparacentesis circulatory dysfunction among patients with cirrhosis and tense ascites, as compared with no treatment. Treatment alternatives to albumin, such as artificial colloids and vasoconstrictors, have been widely investigated. The aim of this meta‐...

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Vydáno v:Hepatology (Baltimore, Md.) Ročník 55; číslo 4; s. 1172 - 1181
Hlavní autoři: Bernardi, Mauro, Caraceni, Paolo, Navickis, Roberta J., Wilkes, Mahlon M.
Médium: Journal Article
Jazyk:angličtina
Vydáno: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.04.2012
Wiley
Wolters Kluwer Health, Inc
Témata:
Albumins - administration & dosage
Albumins - therapeutic use
Ascites - etiology
Ascites - mortality
Ascites - therapy
Biological and medical sciences
Confidence intervals
Female
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Hyponatremia - epidemiology
Hyponatremia - prevention & control
Incidence
Infusions, Intravenous
Liver cirrhosis
Liver Cirrhosis - complications
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical sciences
Meta-analysis
Middle Aged
Mortality
Paracentesis - methods
Randomized Controlled Trials as Topic
Survival Rate
Human
Albumin
Paracentesis
Gastroenterology
ISSN:0270-9139, 1527-3350, 1527-3350
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Shrnutí:Albumin infusion reduces the incidence of postparacentesis circulatory dysfunction among patients with cirrhosis and tense ascites, as compared with no treatment. Treatment alternatives to albumin, such as artificial colloids and vasoconstrictors, have been widely investigated. The aim of this meta‐analysis was to determine whether morbidity and mortality differ between patients receiving albumin versus alternative treatments. The meta‐analysis included randomized trials evaluating albumin infusion in patients with tense ascites. Primary endpoints were postparacentesis circulatory dysfunction, hyponatremia, and mortality. Eligible trials were sought by multiple methods, including computer searches of bibliographic and databases and the Cochrane Library. Results were quantitatively combined under a fixed‐effects model. Seventeen trials with 1,225 total patients were included. There was no evidence of heterogeneity or publication bias. Compared with alternative treatments, albumin reduced the incidence of postparacentesis circulatory dysfunction (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.27‐0.55). Significant reductions in that complication by albumin were also shown in subgroup analyses versus each of the other volume expanders tested (e.g., dextran, gelatin, hydroxyethyl starch, and hypertonic saline). The occurrence of hyponatremia was also decreased by albumin, compared with alternative treatments (OR, 0.58; 95% CI, 0.39‐0.87). In addition, mortality was lower in patients receiving albumin than alternative treatments (OR, 0.64; 95% CI, 0.41‐0.98). Conclusions: This meta‐analysis provides evidence that albumin reduces morbidity and mortality among patients with tense ascites undergoing large‐volume paracentesis, as compared with alternative treatments investigated thus far. (HEPATOLOGY 2012)
Bibliografie:ArticleID:HEP24786
istex:EB66DE9D28105CAE80B01D40E586C8A8C3DBFA90
ark:/67375/WNG-SLDRZ9T3-6
This investigation was supported through an unrestricted grant from CSL Behring, King of Prussia, PA.
Potential conflict of interest: Dr. Navickis and Dr. Wilkes received grants from CSL Behring.
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ISSN:0270-9139
1527-3350
1527-3350
DOI:10.1002/hep.24786