Albumin Utilization in Spontaneous Bacterial Peritonitis

Area of Science:

• Nephrology
• Gastroenterology
• Critical Care Medicine

Background:

• Albumin administration is associated with reduced mortality and acute kidney injury (AKI) in patients with spontaneous bacterial peritonitis (SBP).
• Current guidelines recommend albumin administration within 6 hours of diagnosis for SBP, particularly for high-risk patients identified by specific laboratory markers (serum creatinine >1 mg/dL, BUN >30 mg/dL, or total bilirubin >4 mg/dL).

Purpose of the Study:

• To evaluate the effectiveness of a newly implemented albumin order set specifically designed for high-risk patients diagnosed with SBP.
• To assess the impact of this restricted order set on clinical outcomes and adherence to recommended albumin administration protocols.

Main Methods:

• A retrospective cohort study was conducted from January 1, 2013, to February 28, 2018.
• The albumin order set was introduced on September 20, 2016.
• Inclusion criteria included patients diagnosed with SBP and an ascitic fluid polymorphonuclear count ≥ 250 cells/mm³.

Main Results:

• The incidence of AKI decreased from 63.93% before the order set to 33.33% after (p=0.01).
• Mortality rates significantly dropped from 36.07% to 7.41% (p=0.005) post-implementation.
• Appropriate albumin dosing regimen ordering increased substantially from 42.62% to 96.30% (p<0.001).

Conclusions:

• The albumin order set for high-risk SBP patients effectively reduced the incidence of AKI and mortality.
• The intervention significantly improved the appropriateness of prescribed albumin regimens, enhancing patient care protocols.