American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of the following is an indication for albumin use in cirrhotic patients diagnosed with SBP?

1. Serum creatinine greater than 1.5 mg/dL

2. Serum bilirubin less than 2 mg/dL

3. Blood urea nitrogen greater than 30 mg/dL

4. Serum creatinine less than 1 mg/dL

The correct answer is: Blood urea nitrogen greater than 30 mg/dL

In the context of cirrhotic patients diagnosed with spontaneous bacterial peritonitis (SBP), the use of albumin is indicated particularly when serum creatinine levels exceed 1.5 mg/dL. This is because albumin administration in such cases has been shown to improve outcomes by reducing mortality associated with SBP. The underlying rationale is that higher serum creatinine levels often indicate a worse renal function, which can complicate the patient’s overall condition. When liver disease is present alongside renal impairment, the risk of further complications rises, thus initiating the use of intravenous albumin helps in managing renal function post-SBP treatment. This therapeutic approach has been outlined in various clinical guidelines advocating for the early use of albumin to improve the prognosis in these high-risk patients. In contrast, the other potential options do not meet the thresholds or clinical scenarios that would warrant albumin therapy effectively. For instance, lower serum bilirubin levels or serum creatinine levels under certain thresholds indicate less severe conditions where albumin would not provide the same level of protective benefits as it would in cases of elevated creatinine. Therefore, monitoring renal function in cirrhotic patients with SBP is crucial, and the indication of albumin use aligns with exercise in managing their complex clinical