Albumin Use in Patients With Cirrhosis in France: Results of the “ALBU-LIVE” Survey
Résumé
Introduction
The use of human albumin for the management of cirrhosis has increased. Recommendations have been published for therapeutic paracentesis (TP), spontaneous bacterial peritonitis (SBP), and type 1 hepatorenal syndrome (HRS). The goal of this survey was to assess the prescription practices of French hepatogastroenterologists.
Methods
All hepatogastroenterologists were contacted. The questionnaire evaluated (1) the use of albumin in validated indications and (2) the prescription of albumin for nonvalidated clinical situations.
Results
Responses were analyzed from 451 (50.1%) practitioners. The mean age was 40 years (range, 24 to 67 y). Physicians practiced in a university hospital (47.7%) or a general hospital (45.8%). There were 56.7% senior practitioners. Overall 99.6% of the practitioners compensated for TP. Albumin was used by 87.8% of the physicians, with a fixed dose being used by 84.6%. For SBP, 94% of the physicians used albumin concomitantly with antibiotics. The recommended protocol was followed by 56.2% of the practitioners: more often by senior university hospital practitioners than by senior general hospital practitioners (P=0.015). About 66.5% used albumin infusion for the diagnosis of HRS: used more often by senior university hospital practitioners (P=0.0006). Albumin was used concomitantly with vasopressor treatment by 84%; the dose and the duration varied considerably. About 23.5% used albumin for severe bacterial infection, 47.9% for severe hyponatremia, 43.9% for severe hypoalbuminemia, and 65.9% for hydrothorax.
Conclusions
In this large French survey, albumin is only prescribed in accordance with recommendations for TP. The schedule for SBP is followed by only 56% of the practitioners. The use of albumin for HRS is not adapted to recommendations, which are not well known, suggesting that they should be more diffused.
Mots clés
Practice Guidelines as Topic
Practice Patterns
Physicians' / standards
Physicians' / trends
Prospective Studies
Serum Albumin
Human / administration & dosage
Human / adverse effects
Treatment Outcome
Young Adult
dult
Aged
Female
France
Gastroenterologists / standards
Gastroenterologists / trends
Guideline Adherence / trends
Health Care Surveys
Humans
Infusions Intravenous
Liver Cirrhosis / complications
Liver Cirrhosis / diagnosis
Liver Cirrhosis / drug therapy
Male
Middle Aged