Albumin infusion improves outcomes of patients with spontaneous bacterial peritonitis: a meta-analysis of randomized trials

Clin Gastroenterol Hepatol. 2013 Feb;11(2):123-30.e1. doi: 10.1016/j.cgh.2012.11.007. Epub 2012 Nov 22.


Background & aims: Renal impairment increases mortality among patients with spontaneous bacterial peritonitis (SBP), despite administration of non-nephrotoxic antibiotics. Albumin infusion has been reported to reduce renal impairment and mortality in patients with SBP. We performed a meta-analysis of randomized controlled trials (RCTs) to quantify the effect of albumin infusion on renal impairment and mortality in patients with SBP.

Methods: We searched MEDLINE, EMBASE, the Cochrane Library, and for RCTs that evaluated albumin treatment for patients with SBP; we also performed searches by additional methods. Four trials of 288 total patients were included in our analysis. Data were quantitatively combined under a fixed-effects model.

Results: We found no evidence of statistically significant heterogeneity or publication bias among the studies analyzed. Albumin was compared with no albumin in 3 trials and with artificial colloid in 1 trial. All patients received antibiotics. The incidence of renal impairment in control groups was 44 of 144 (30.6%), compared with 12 of 144 (8.3%) in groups given albumin. The pooled odds ratio for a reduction in renal impairment after albumin infusion was 0.21 (95% confidence interval, 0.11-0.42). Odds ratios for renal impairment after albumin therapy ranged from 0.19-0.30 among the individual studies. Mortality among controls was 51 of 144 (35.4%), compared with 23 of 144 (16.0%) among patients who received albumin. The pooled odds ratio for decreased mortality after infusion of albumin was 0.34 (95% confidence interval, 0.19-0.60). Odds ratios for mortality in individual RCTs ranged from 0.16-0.55.

Conclusions: In a meta-analysis of 4 RCTs (288 patients), albumin infusion prevented renal impairment and reduced mortality among patients with SBP.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Albumins / administration & dosage*
  • Bacterial Infections / complications
  • Bacterial Infections / drug therapy*
  • Bacterial Infections / mortality
  • Female
  • Humans
  • Male
  • Middle Aged
  • Peritonitis / complications
  • Peritonitis / drug therapy*
  • Peritonitis / mortality
  • Randomized Controlled Trials as Topic
  • Renal Insufficiency / prevention & control*
  • Survival Analysis
  • Treatment Outcome
  • Young Adult


  • Albumins