Albumin for Spontaneous Bacterial Peritonitis: Care Variation, Disparities, and Outcomes.

IF 7.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY American Journal of Gastroenterology Pub Date : 2024-11-12 DOI:10.14309/ajg.0000000000003190

Marina Serper, Marya E Pulaski, Siqi Zhang, Tamar H Taddei, David E Kaplan, Nadim Mahmud

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Abstract

Introduction: Intravenous albumin reduces mortality in spontaneous bacterial peritonitis (SBP). We sought to characterize albumin use for SBP over time and investigate patient-level and hospital-level factors associated with use.

Methods: A retrospective cohort study in the Veterans Health Administration between 2008 and 2021 evaluated trends and patient-level, practice-level, and facility-level factors associated with use among patients with cirrhosis hospitalized for SBP confirmed with ascitic fluid criteria.

Results: Among 3,871 veterans with SBP, 803 (20.7%) did not receive albumin, 1,119 (28.9%) received albumin but not per guidelines, and 1,949 (50.3%) received albumin per guidelines; use increased from 66% in 2008 to 88% in 2022. Veterans who identified as Black compared with White were less likely to receive guideline-recommended albumin (Odds ratio [OR] 0.76, 95% confidence interval [CI] 0.59-0.98) in all analyses. Guideline-recommended albumin was more likely to be administered to veterans with Child-Turcotte-Pugh class B (OR 1.39, 95% CI 1.17-1.64) and C (OR 2.21, 95% CI 1.61-3.04) compared with Child-Turcotte-Pugh A; and acute kidney injury Stage 1 (OR 1.48, 95% CI 1.22-1.79), Stage 2 (OR 2.17, 95% CI 1.62-2.91), and Stage 3 (OR 1.68, 95% CI 1.18-2.40) compared with no acute kidney injury. gastroenterology/hepatology consultation (OR 1.60, 95% CI 1.29-1.99), nephrology consultation (OR 1.60, 95% CI 1.23-2.07), and having both gastroenterology/hepatology and nephrology consultations (OR 2.17, 95% CI 1.60-2.96) were associated with higher albumin administration. In exploratory analyses accounting for interactions between model for end-stage liver disease sodium and albumin, guideline-recommended albumin was associated with lower in-hospital mortality (HR 0.90, 95% CI 0.85-0.96).

Discussion: Future studies should investigate optimizing albumin use for SBP to reduce the variability and mitigate healthcare disparities.

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白蛋白治疗自发性细菌性腹膜炎：护理差异、差距和结果。

背景：静脉注射白蛋白可降低SBP的死亡率。我们试图描述随着时间推移白蛋白在 SBP 中的使用情况，并调查与使用相关的患者和医院层面的因素：方法：退伍军人健康管理局在 2008 年至 2021 年期间开展了一项回顾性队列研究，评估了因腹水标准确诊为 SBP 而住院的肝硬化患者使用白蛋白的趋势以及患者、医生和医院层面的相关因素：在 3,871 名患有 SBP 的退伍军人中，有 803 人（20.7%）未接受白蛋白治疗，1,119 人（28.9%）接受了白蛋白治疗但未按指南要求，1,949 人（50.3%）按指南要求接受了白蛋白治疗；使用率从 2008 年的 66% 上升到 2022 年的 88%。在所有分析中，与白人相比，黑人退伍军人接受指南推荐的白蛋白的可能性较低（OR 0.76，95%CI 0.59-0.98）。与 CTP A 相比，CTP B 级（OR 1.39，95%CI 1.17-1.64）和 C 级（OR 2.21，95%CI 1.61-3.04）退伍军人更有可能获得指南推荐的白蛋白；与无 AKI 相比，AKI 1 期（OR 1.48，95%CI 1.22-1.79）、2 期（OR 2.17，95%CI 1.62-2.91）和 3 期（OR 1.68，95%CI 1.18-2.40）退伍军人更有可能获得指南推荐的白蛋白。消化内科/肝病科会诊（OR 1.60，95%CI 1.29--1.99）、肾病科会诊（OR 1.60，95%CI 1.23-2.07）以及消化内科/肝病科和肾病科会诊（OR 2.17，95%CI 1.60-2.96）与白蛋白用量增加有关。在考虑终末期肝病钠模型（MELD-Na）和白蛋白之间相互作用的探索性分析中，指南推荐的白蛋白与较低的院内死亡率相关（HR 0.90，95% CI 0.85 - 0.96）：今后的研究应探讨如何优化白蛋白在 SBP 中的应用，以减少变异性并缩小医疗差距。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Gastroenterology 医学-胃肠肝病学

CiteScore

11.40

自引率

5.10%

发文量

458

审稿时长

12 months

期刊介绍： Published on behalf of the American College of Gastroenterology (ACG), The American Journal of Gastroenterology (AJG) stands as the foremost clinical journal in the fields of gastroenterology and hepatology. AJG offers practical and professional support to clinicians addressing the most prevalent gastroenterological disorders in patients.