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Albumin Use in Patients With Cirrhosis in France: Results of the “ALBU-LIVE” SurveyA Case for Better EASL Guidelines Diffusion and/or Revision

Garioud, Armand MD*; Cadranel, Jean-François MD, Pr CMHP*; Pauwels, Arnaud MD; Nousbaum, Jean-Baptiste MD, PhD; Thévenot, Thierry MD, PhD§; Dao, Thong MD, PhD; Louvet, Alexandre MD, PhD; Sogni, Philippe MD, PhD#; Talbodec, Nathalie MD**; Antonini, Teresa M. MD††; Bureau, Christophe MD, PhD‡‡; Thabut, Dominique MD, PhD§§; Elkrief, Laure MD∥∥; Jouannaud, Vincent MD¶¶; Macaigne, Gilles MD##; Bernard-Chabert, Brigitte MD***; Lison, Hortensia MD*; Alric, Laurent MD, PhD†††; Carbonell, Nicolas MD‡‡‡; Labadie, Héléne MD§§§; Amiot, Xavier MD∥∥∥; Abergel, Armand MD, PhD¶¶¶; Hanslik, Bertrand MD###; Leroy, Vincent MD, PhD****; De Lédinghen, Victor MD, PhD††††; Denis, Jacques MD‡‡‡‡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 of Clinical Gastroenterology: October 2017 - Volume 51 - Issue 9 - p 831–838
doi: 10.1097/MCG.0000000000000735
LIVER, PANCREAS AND BILIARY TRACT: Original Articles

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.

*Service d’Hépato-gastroentérologie, de Nutrition et d’Alcoologie, GHPSO, Creil

Service d’Hépato-gastroentérologie, Centre Hospitalier de Gonesse, Gonesse

Service d’Hépato-gastroentérologie, CHRU La Cavale Blanche, Brest

§Service d’Hépatologie, CHRU Jean Minjoz, Besançon

Service d’Hépato-gastroentérologie, CHU, Caen

Service d’Hépatologie, CHRU, Lille

#Service d’Hépatologie, CHU Cochin

§§Service d’Hépatologie, CHU Pitié-Salpêtrière

‡‡‡Service d’Hépatologie, CHU Saint-Antoine

∥∥∥Service d’Hépato-gastroentérologie, CHU Tenon, Paris

**Service d’Hépato-gastroentérologie, Centre Hospitalier, Tourcoing

††Service d’Hépatologie, Centre Hépatobiliaire, Villejuif

‡‡Service d’Hépato-gastroentérologie

†††Service de Médecine Interne, CHU, Toulouse

∥∥Service d’Hépatologie, CHU Beaujon, Clichy-la-Garenne

¶¶Service d’Hépato-gastroentérologie, Centre Hospitalier, Montfermeil

##Service d’Hépato-gastroentérologie, Centre Hospitalier, Lagny-sur-Marne

***Service d’Hépatologie, CHU, Reims

§§§Service d’Hépato-gastroentérologie, Centre Hospitalier, Saint-Denis

¶¶¶Service d’Hépato-gastroentérologie, CHU, Clermont-Ferrand

###Cabinet médical, Montpellier

****Service d’Hépato-gastroentérologie, CHU, Grenoble

††††Service d’Hépato-gastroentérologie, CHU, Pessac

‡‡‡‡Service d’Hépato-gastroentérologie, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France

A.G. and J.-F.C. contributed equally.

The authors declare that they have nothing to disclose.

Address correspondence to: Armand Garioud, MD, Service d’Hépato-gastroentérologie, de Nutrition et d’Alcoologie, Groupe Hospitalier Public du Sud de l’Oise (GHPSO), boulevard Laennec, 60109 Creil Cedex 1, France (e-mail: armand.garioud@ghpso.fr).

Received March 31, 2016

Accepted August 13, 2016

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