Albumin Use in Patients With Cirrhosis in France: Results of the "ALBU-LIVE" Survey: A Case for Better EASL Guidelines Diffusion and/or Revision.

Abstract

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.

• Authors: Armand Garioud, Jean-François Cadranel, Arnaud Pauwels, Jean-Baptiste Nousbaum, Thierry Thévenot, Thong Dao, Alexandre Louvet, Philippe Sogni, Nathalie Talbodec, Teresa M Antonini, Christophe Bureau, Dominique Thabut, Laure Elkrief, Vincent Jouannaud, Gilles Macaigne, Brigitte Bernard-Chabert, Hortensia Lison, Laurent Alric, Nicolas Carbonell, Héléne Labadie, Xavier Amiot, Armand Abergel, Bertrand Hanslik, Vincent Leroy, Victor De Lédinghen, Jacques Denis, Association Nationale des Hépato-gastroentérologues des Hôpitaux Généraux de France, Association Française pour l’Etude du Foie, Club de Réflexion des Cabinets et Groupes d’Hépato-Gastroentérologie
• Journal: Journal of clinical gastroenterology (J Clin Gastroenterol) Vol. 51 Issue 9 Pg. 831-838 (Oct 2017) ISSN: 1539-2031 [Electronic] United States
• PMID: 28787354 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• ALB protein, human
• Serum Albumin, Human

Topics

• Adult
• Aged
• Female
• France
• Gastroenterologists (standards, trends)
• Guideline Adherence (trends)
• Health Care Surveys
• Humans
• Infusions, Intravenous
• Liver Cirrhosis (complications, diagnosis, drug therapy)
• Male
• Middle Aged
• Practice Guidelines as Topic
• Practice Patterns, Physicians' (standards, trends)
• Prospective Studies
• Serum Albumin, Human (administration & dosage, adverse effects)
• Treatment Outcome
• Young Adult