CHEST Guidelines-Retrospective-Outcomes-of-Patients-With-Spontaneou

Retrospective-Outcomes-of-Patients-With-Spontaneou

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The study investigates the impact of intravenous (IV) albumin treatment on patients with spontaneous bacterial empyema (SBEM), a pleural space infection occurring in people with liver cirrhosis and hepatic hydrothorax. Historically, SBEM treatment focuses on antibiotics, with some experts suggesting albumin based on its success with spontaneous bacterial peritonitis, though its efficacy in SBEM remains untested.<br /><br />The study used a database of hospital records from 2011 to 2016 to identify individuals with SBEM, which affects 13% to 16% of cirrhotic patients. 39 patients met the study’s criteria, undergoing thoracentesis without pneumonia confirmation and having elevated pleural fluid neutrophil counts. Group comparisons were made between those who received albumin and those who didn't, analyzing the 90-day mortality rate alongside Model for End-Stage Liver Disease (MELD) 3.0 scores that predict mortality.<br /><br />Results showed that 23% of studied patients received albumin. The mortality within 90 days was 22% for patients treated with albumin, compared to 47% for those without. Although the difference wasn't statistically significant likely due to the small sample size, a trend of lower mortality in the albumin group was noted. The study could not establish a definitive causal link due to confounders and limitations like sample size and retrospective data collection.<br /><br />The findings hint at potential benefits of albumin treatment in SBEM, but stress the need for further research with more robust and randomized trial designs. The investigators concluded that larger studies would be required to adjust for confounding factors and ascertain albumin's impact accurately, suggesting albumin might mitigate mortality in patients facing severe liver disease conditions.

Keywords

intravenous albumin

spontaneous bacterial empyema

liver cirrhosis

hepatic hydrothorax

antibiotics

90-day mortality

MELD scores

thoracentesis

pleural fluid neutrophil

randomized trial