Effects of intravenous albumin in patients with cirrhosis and episodic hepatic encephalopathy: A randomized double-blind study
Por:
Simon-Talero, M, Garcia-Martinez, R, Torrens, M, Augustin, S, Gomez, S, Pereira, G, Guevara, M, Gines, P, Soriano, G, Roman, E, Sanchez-Delgado, J, Ferrer, R, Nieto, JC, Sunye, P, Fuentes, I, Esteban, R, Cordoba, J
Publicada:
1 dic 2013
Resumen:
Background & Aims: Episodic hepatic encephalopathy is frequently precipitated by factors that induce circulatory dysfunction, cause oxidative stress-mediated damage or enhance astrocyte swelling. The administration of albumin could modify these factors and improve the outcome of hepatic encephalopathy. The aim of this study is to assess the efficacy of albumin in a multicenter, prospective, double-blind, controlled trial (ClinicalTrials.gov number, NCT00886925).
Methods: Cirrhotic patients with an acute episode of hepatic encephalopathy (grade II-IV) were randomized to receive albumin (1.5 g/kg on day 1 and 1.0 g/kg on day 3) or isotonic saline, in addition to the usual treatment (laxatives, rifaximin 1200 mg per day). The primary end point was the proportion of patients in which encephalopathy was resolved on day 4. The secondary end points included survival, length of hospital stay, and biochemical parameters.
Results: Fifty-six patients were randomly assigned to albumin (n = 26) or saline (n = 30) stratified by the severity of HE. Both groups were comparable regarding to demographic data, liver function, and precipitating factors. The percentage of patients without hepatic encephalopathy at day 4 did not differ between both groups (albumin: 57.7% vs. saline: 53.3%; p >0.05). However, significant differences in survival were found at day 90 (albumin: 69.2% vs. saline: 40.0%; p = 0.02).
Conclusions: Albumin does not improve the resolution of hepatic encephalopathy during hospitalization. However, differences in survival after hospitalization suggest that the development of encephalopathy may identify a subgroup of patients with advanced cirrhosis that may benefit from the administration of albumin. (C) 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Filiaciones:
Simon-Talero, M:
Univ Autonoma Barcelona, Liver Unit, Dept Internal Med, Hosp Univ Vall dHebron,Inst Recerca VHIR, E-08193 Barcelona, Spain
Garcia-Martinez, R:
Univ Autonoma Barcelona, Liver Unit, Dept Internal Med, Hosp Univ Vall dHebron,Inst Recerca VHIR, E-08193 Barcelona, Spain
Torrens, M:
Univ Autonoma Barcelona, Liver Unit, Dept Internal Med, Hosp Univ Vall dHebron,Inst Recerca VHIR, E-08193 Barcelona, Spain
Augustin, S:
Univ Autonoma Barcelona, Liver Unit, Dept Internal Med, Hosp Univ Vall dHebron,Inst Recerca VHIR, E-08193 Barcelona, Spain
Gomez, S:
Hosp Univ Vall dHebron, Neuropsychol Unit, Barcelona, Spain
Pereira, G:
Univ Barcelona, Hosp Clin, Liver Unit, Barcelona, Spain
Guevara, M:
Univ Barcelona, Hosp Clin, Liver Unit, Barcelona, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Inst Invest Biomed August Pi Sunyer IDIBAPS, Barcelona, Spain
Gines, P:
Univ Barcelona, Hosp Clin, Liver Unit, Barcelona, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Inst Invest Biomed August Pi Sunyer IDIBAPS, Barcelona, Spain
Soriano, G:
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Univ Autonoma Barcelona, Dept Gastroenterol, Hosp Santa Creu & St Pau, Barcerlona, Spain
Roman, E:
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Univ Autonoma Barcelona, Dept Gastroenterol, Hosp Santa Creu & St Pau, Barcerlona, Spain
Sanchez-Delgado, J:
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Univ Autonoma Barcelona, Digest Dis Dept, Hosp Parc Tauli Sabadell, E-08193 Barcelona, Spain
Ferrer, R:
Univ Autonoma Barcelona, Dept Biochem, Hosp Univ Vall dHebron, E-08193 Barcelona, Spain
Nieto, JC:
Univ Autonoma Barcelona, Dept Immunol, Hosp Santa Creu & St Pau, E-08193 Barcelona, Spain
Sunye, P:
Hosp Univ Vall dHebron, Dept Pharm, Barcelona, Spain
Fuentes, I:
Hosp Univ Vall dHebron, Inst Recerca VHIR, UCICAC, Barcelona, Spain
Esteban, R:
Univ Autonoma Barcelona, Liver Unit, Dept Internal Med, Hosp Univ Vall dHebron,Inst Recerca VHIR, E-08193 Barcelona, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Cordoba, J:
Univ Autonoma Barcelona, Liver Unit, Dept Internal Med, Hosp Univ Vall dHebron,Inst Recerca VHIR, E-08193 Barcelona, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
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