Federal University of Health Sciences of Porto Alegre, Graduate Program in Medicine: Hepatology, Porto Alegre, Brazil. Federal University of Health Sciences of Porto Alegre, Gastroenterology and Hepatology Unit, Porto Alegre, Brazil. Irmandade Santa Casa de Misericordia de Porto Alegre, Gastroenterology and Hepatology Unit, Porto Alegre, Brazil.
BACKGROUND AND AIM Bacterial infections are among the main causes of death in patients with cirrhosis. While there are unquestionable benefits of using albumin in patients with spontaneous bacterial peritonitis, the benefits of albumin are controversial for those with extraperitoneal infections. The aim was to compare the use of albumin associated to antibiotics and antibiotics alone in cirrhotic patients with
extraperitoneal infections. METHODS A systematic review was performed using MEDLINE and EMBASE databases. Randomized controlled trials comparing albumin associated to antibiotics and antibiotics alone in cirrhotic patients with extraperitoneal infections were considered eligible, as long as at least one of the following outcomes was evaluated: mortality; renal dysfunction. Meta-analysis was performed using the random effects model, through the Mantel-Haenszel method. The study protocol was registered at PROSPERO platform (CRD42018107191). RESULTS The literature search yielded 812 references. Three randomized controlled trials fulfilled the selection criteria and were included in this meta-analysis. There was no evidence of significant difference between the groups regarding mortality in 30 days (risk ratio - RR = 1.62, 95% confidence interval - CI: 0.92 - 2.84, p = 0.09, I(2) = 0%) or in 90 days (RR = 1.27, 95%CI: 0.89 - 1.83, p = 0.19, I(2) = 0%). Regarding renal dysfunction, there was also no evidence of significant difference between the groups (RR = 0.55, 95%CI: 0.25 - 1.19, p = 0.13, I(2) = 0%). CONCLUSION There is no evidence of significant benefits of using albumin for cirrhotic patients with extraperitoneal infections regarding mortality or renal dysfunction.
