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Albumin for Spontaneous Bacterial Peritonitis: Care Variation, Disparities, and Outcomes
Marina Serper1,2,3, Marya E Pulaski2, Siqi Zhang4
1Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.
The American Journal of Gastroenterology
|November 12, 2024
Summary
Albumin use for spontaneous bacterial peritonitis (SBP) increased significantly, yet disparities persist. Guideline-recommended albumin was associated with lower mortality, highlighting its importance in SBP management.
Area of Science:
- Hepatology and Gastroenterology
- Critical Care Medicine
- Health Services Research
Background:
- Intravenous albumin administration is a proven mortality-reducing therapy for spontaneous bacterial peritonitis (SBP).
- Characterizing albumin use patterns and associated factors in SBP is crucial for optimizing patient outcomes.
- Understanding patient- and hospital-level influences on albumin administration can identify areas for practice improvement.
Purpose of the Study:
- To analyze temporal trends in intravenous albumin use for SBP within the Veterans Health Administration.
- To identify patient-level and hospital-level factors associated with guideline-recommended albumin administration for SBP.
- To explore the association between guideline-adherent albumin use and in-hospital mortality in SBP patients.
Main Methods:
- Retrospective cohort study utilizing data from the Veterans Health Administration (2008-2021).
- Inclusion criteria: Cirrhosis patients hospitalized with SBP confirmed by ascitic fluid analysis.
- Analysis of trends, patient demographics, clinical factors (Child-Turcotte-Pugh class, AKI stage), consultations, and mortality.
Main Results:
- Albumin use for SBP increased from 66% in 2008 to 88% in 2022.
- Guideline-recommended albumin was administered to 50.3% of patients; 20.7% received no albumin.
- Factors associated with lower guideline-recommended albumin use included identifying as Black. Factors associated with higher use included higher Child-Turcotte-Pugh class, presence of AKI, and specialist consultations (Gastroenterology/Hepatology, Nephrology).
- Guideline-recommended albumin was associated with reduced in-hospital mortality (HR 0.90).
Conclusions:
- While albumin use for SBP has increased, significant variability and healthcare disparities in administration persist.
- Patient clinical status (liver disease severity, AKI) and specialist involvement influence guideline adherence.
- Further research is needed to optimize albumin use strategies for SBP to minimize disparities and improve outcomes.
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