白蛋白可以增加存活一些肝硬化肝性脑病患者

StephenW

Albumin may increase survival for some cirrhotic patients with hepatic encephalopathy

Simón-Talero M. J Hepatol. 2013;59:1184-1192.

   

    December 10, 2013

A study to determine whether administration of albumin could improve the outcome of hepatic encephalopathy patients instead demonstrated significantly improved survival rates.


“Our study found a major impact of albumin infusion on 90-day survival in patients that experience an episode of HE [hepatic encephalopathy],” the researchers wrote. “The results are independent of the effects on HE, suggesting that HE itself identifies a group of cirrhotic patients with high mortality who benefit from albumin infusion.”

The multicenter, prospective, double blind, controlled trial randomly assigned 56 cirrhotic patients with an acute episode of HE to albumin (1.5g/kg on day 1 and 1g/kg on day 3) or isotonic saline, along with standard treatment (laxatives, 1,200 mg rifaximin daily). The patients were stratified by HE severity (grades 2 and 3 or grade 4). Thirty patients were assigned to saline and 26 to albumin.

Primary endpoint was resolution of HE by day 4; secondary endpoints included survival, length of hospital stay, and biochemical parameters. At day 4, there was no significant difference in patients with HE.

At day 90, 14 initial saline patients had died compared with six in the albumin group. Causes of death were: multiorgan failure (seven in saline group, two in albumin group), sepsis associated with multiorgan failure (four in saline group, three in albumin group) and gastrointestinal bleeding (three in saline group, one in albumin group).

Transplant-free survival among patients in the albumin group demonstrated a comparative HR of 0.37 (CI 95%; 0.16–0.89).

Based on the results, the researchers suggested the need for another study that replicates the design of this study but focuses on survival instead of HE.

StephenW

西蒙 - Talero 10月8肝脏病。 2013 ; 59:1184-1192 。

   
2013年12月10日

研究确定白蛋白能否改善肝性脑病患者的预后，而不是表现出显著提高生存率。

“我们的研究发现在体验何[肝性脑病]一个小插曲患者输注白蛋白在90天的生存产生重大影响， ”研究人员写道。 “结果是独立于何的影响，这表明他本身标识一组肝硬化患者的高死亡率从谁输注白蛋白受益的。 ”

该多中心，前瞻性，双盲，对照试验随机分配56例肝硬化患者HE急性发作白蛋白（ 1.5g/kg上3天1天及为1g/kg ）或等渗盐水，随着标准治疗（泻药， 1200毫克利福昔明每日） 。患者均经HE的严重程度（等级2和3或4级）分层。 30例患者被分配到生理盐水和26白蛋白。

主要终点是他的第4天的分辨率;次要终点包括生存，住院天数，和生化指标。在第4天，有患者何无显著差异。

在90日， 14初始生理盐水患者曾与白蛋白组在六个月相比，死亡。死亡原因为：多器官功能衰竭（生理盐水组7 ，两人在白蛋白组），多器官功能衰竭（四生理盐水组，三个在白蛋白组）和胃肠道出血（ 3生理盐水组，一个在白蛋白组）相关的败血症。

在患者的白蛋白组在移植生存证明的0.37比较HR（ 95％CI ， 0.16-0.89 ） 。

基于这些结果，研究人员建议，需要另一项研究中，复制这项研究的设计，但侧重于生存，而不是HE。

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