[220] Intravenous Albumin Is Not Necessary in Cirrhotic Patients With Spontaneous Bacterial Peritonitis and Low-Risk of Mortality

Casas, Meritxell; Soriano, Germán; Ayala, Edgar; Guarner–Argente, Carlos; Ordás, Íngrid; Mercé, J; Balanzó, Joaquím; Guarner, Carlos

doi:10.1016/s0168-8278(07)61818-2

Cited by 14 publications

(6 citation statements)

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“…This is based on a non–placebo‐controlled study in patients with SBP, in which the intravenous administration of albumin decreased the risk of HRS by 66% compared with antibiotic treatment alone 82. However, the benefit of albumin is observed mainly in patients with SCr greater than 1.0, urea greater than 30 mg/dL, or a serum bilirubin greater than 4 mg/dL,82–84 that is, patients who already have some degree of renal dysfunction at the time of the diagnosis of SBP.…”

Section: Preventionmentioning

confidence: 99%

Acute kidney injury in cirrhosis

2008

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Section: Preventionmentioning

confidence: 99%

Acute kidney injury in cirrhosis

2008

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“…Renal impairment occurs in < 10% of patients when serum bilirubin is < 4 mg/dL and serum creatinine is < 1 mg/ dL. 104,105 As albumin is an expensive blood product with associated risks, its use should be limited to high-risk patients (bilirubin > 4 mg/dL, creatinine > 1 mg/dL) with SBP.…”

Section: Treatmentmentioning

confidence: 99%

Bacterial Infections, Sepsis, and Multiorgan Failure in Cirrhosis

2008

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Bacterial infections are an important complication of cirrhosis, particularly in hospitalized patients. In this article we review the prevalence, risk factors, and pathogenesis of bacterial infections in cirrhosis, focusing on the mechanisms of bacterial translocation such as impaired immunity and bacterial overgrowth, as well as maneuvers that may inhibit bacterial translocation and could be used not only to prevent infections but also to ameliorate the hyperdynamic circulatory state of cirrhosis. We also review the clinical features and management of the most common infection in cirrhosis, spontaneous bacterial peritonitis (SBP), specifically the evidence behind the therapy of acute SBP, the role of albumin, and the role of antibiotics in the prophylaxis of high-risk patients. It has been recognized that SBP and other bacterial infections lead to the systemic inflammatory response syndrome, sepsis, and multiorgan failure. We review the pathogenesis and management of these complications, the role of adrenal insufficiency, and the utility of intensive care prognostic models.

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“…In patients with cirrhosis, an open‐label unblinded randomized clinical trial (RCT) in patients with SBP (without shock) treated with cefotaxime showed that the intravenous administration of a 20% albumin solution reduced the incidence of renal failure and decreased mortality rates from 29% to 10% 41. This effect was not observed in patients with a low risk of mortality (total bilirubin <4 mg/dL and creatinine <1 mg/dL) 53. A recent small unblinded RCT suggested that a 20% albumin solution improved systemic hemodynamics better than a 6% hydroxyethylstarch solution in SBP 54.…”

Section: Management Of Severe Sepsis and Septic Shock In Patients Witmentioning

confidence: 99%

Mediation of the proinflammatory cytokine response in rheumatoid arthritis and spondylarthritis by interactions between fibroblast‐like synoviocytes and natural killer cells

Chan¹,

Filer²,

Parsonage³

et al. 2008

Arthritis & Rheumatism

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Objective. Fibroblast-like synoviocytes (FLS) are potentially directly involved in the propagation of inflammation. We have previously shown evidence of an expanded activated population of natural killer (NK) cells in spondylarthritis (SpA) patients. In the present study, we sought to determine whether the interaction between NK cells and FLS from SpA patients results in a proinflammatory response.Methods. Autologous NK cells and FLS were obtained from 6 patients with SpA, 4 patients with rheumatoid arthritis (RA), and 8 patients with osteoarthritis (OA). Physical interactions between NK cells and FLS were studied by time-lapse phase-contrast microscopy. Fluorescence-activated cell sorting was used to study the activation, proliferation, and survival of NK cells in contact with FLS. Cytokine and stromal factor production were measured by a multiple cytokine bead assay.Results. NK cells both adhered to and migrated beneath the FLS monolayer (pseudoemperipolesis).

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[220] Intravenous Albumin Is Not Necessary in Cirrhotic Patients With Spontaneous Bacterial Peritonitis and Low-Risk of Mortality

Cited by 14 publications

References 0 publications

Acute kidney injury in cirrhosis

Acute kidney injury in cirrhosis

Bacterial Infections, Sepsis, and Multiorgan Failure in Cirrhosis

Mediation of the proinflammatory cytokine response in rheumatoid arthritis and spondylarthritis by interactions between fibroblast‐like synoviocytes and natural killer cells

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