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

Abstract

Intravenous albumin reduces mortality in SBP. We sought to characterize albumin use for SBP over time and investigate patient and hospital-level factors associated with use. A retrospective cohort study in the Veterans Health Administration between 2008 and 2021 evaluated trends and patient, practice-, and facility-level factors associated with use among patients with cirrhosis hospitalized for SBP confirmed with ascitic fluid criteria. 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 to white were less likely to receive guideline-recommended albumin (OR 0.76, 95%CI 0.59-0.98) in all analyses. Guideline-recommended albumin was more likely to be administered to Veterans with CTP class B (OR 1.39, 95% CI 1.17-1.64) and C (OR 2.21, 95% CI 1.61-3.04) compared to CTP A; and AKI 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 to no AKI. GI/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 GI/hep 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 (MELD-Na) and albumin, guideline-recommended albumin was associated with lower in-hospital mortality (HR 0.90, 95% CI 0.85 - 0.96). Future studies should investigate optimizing albumin use for SBP to reduce variability and mitigate healthcare disparities.