Albumin use in spontaneous bacterial peritonitis reduces incidence of AKI, mortality

The albumin order set restricted to patients with high-risk spontaneous bacterial peritonitis (SBP) leads to a marked decrease in the incidence of acute kidney injury (AKI) and mortality, reports a study. In addition, it has improved the suitability of albumin regimen ordered.

The authors, led by Alex M Ebied from High Point University Fred Wilson School of Pharmacy, North Carolina, US, examined the effect of an albumin order set restricted to high-risk SBP in this retrospective cohort study conducted between 1 January 2013 to 28 February 2018. The albumin order set was implemented on 20 September 2016.

Patients were eligible if they were diagnosed with SBP and if they had an ascitic fluid polymorphonuclear count ≥250 cells/mm³. A total of 137 patients were identified, of which 88 were eligible for analysis.

AKI incidence in the pre- and postorder sets were 63.93 percent and 33.33 percent (p=0.01), respectively, while that of mortality were 36.07 percent and 7.41 percent (p=0.005), respectively.

The proportion of patients administered albumin within 6 hours were 24.59 percent in the preorder set and 40.74 percent in the postorder set (p=0.14), while the percentage of those who received the recommended albumin dosing regimen ordered was 42.62 percent and 96.30 percent (p<0.001), respectively.

“Albumin has been shown to decrease the incidence of mortality and AKI in patients with SBP,” the authors said.

“Albumin administration in SBP is recommended within 6 hours of diagnosis and for reserved use in high-risk patients with the following baseline laboratory tests: serum creatinine >1 mg/dL, blood urea nitrogen >30 mg/dL, or total bilirubin >4 mg/dL,” they added.