Effect of intravenous albumin on systemic and hepatic hemodynamics and vasoactive neurohormonal systems in patients with cirrhosis and spontaneous bacterial peritonitis

J Hepatol. 2004 Sep;41(3):384-90. doi: 10.1016/j.jhep.2004.05.009.


Background/aims: Albumin administration prevents renal failure and improves survival in spontaneous bacterial peritonitis. This study characterizes the mechanisms of action of albumin in this condition.

Methods: Systemic and splanchnic hemodynamics, plasma renin activity and plasma concentration of interleukin-6, serum concentration of nitric oxide and ascitic fluid levels of nitric oxide and interleukin-6 were assessed at diagnosis and resolution of infection in 12 patients with spontaneous bacterial peritonitis treated with ceftriaxone plus albumin. At infection resolution there was a significant improvement in circulatory function, as indicated by a significant increase in mean arterial pressure (+8%, P=0.02), a fall in heart rate (-10%, P=0.01), a suppression of plasma renin activity (-67%, P=0.002) and a decrease in creatinine levels. These changes were related to both an increase in cardiac work (stroke work index: +18%, P=0.005) and in peripheral vascular resistance (+14%, P=0.05). The improvement in cardiac function was due to an increase in filling. No significant changes were observed in portal pressure or hepatic blood flow.

Conclusions: These results indicate that the beneficial effects of albumin administration on systemic hemodynamics and renal function in spontaneous bacterial peritonitis are related to both an improvement in cardiac function and a decrease in the degree of arterial vasodilation.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Albumins / administration & dosage*
  • Anti-Bacterial Agents / therapeutic use
  • Ascitic Fluid / metabolism
  • Bacterial Infections / complications*
  • Bacterial Infections / drug therapy*
  • Ceftriaxone / therapeutic use
  • Female
  • Hemodynamics / drug effects
  • Humans
  • Injections, Intravenous
  • Interleukin-6 / blood
  • Interleukin-6 / metabolism
  • Liver Circulation / drug effects
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / drug therapy*
  • Liver Cirrhosis / physiopathology
  • Male
  • Middle Aged
  • Nitric Oxide / blood
  • Nitric Oxide / metabolism
  • Peritonitis / complications*
  • Peritonitis / drug therapy*
  • Peritonitis / physiopathology
  • Renin / blood


  • Albumins
  • Anti-Bacterial Agents
  • Interleukin-6
  • Nitric Oxide
  • Ceftriaxone
  • Renin