A 52-year-old man with Child-Pugh B cirrhosis from NASH develops spontaneous bacterial peritonitis (SBP, SAAG 1.3 g/dL, ascitic PMN >250/µL). After starting IV cefotaxime, which adjunctive therapy has been shown in the SORT trial (Sort et al., 1999, NEJM) to significantly reduce the risk of hepatorenal syndrome and improve survival?
- A Midodrine + octreotide for vasoconstrictive support
- B Intravenous albumin infusion (1.5 g/kg on day 1, 1 g/kg on day 3) ✓
- C Prophylactic terlipressin infusion
- D Fresh frozen plasma to correct INR >2
Explanation
The landmark SORT trial (Sort et al., NEJM 1999) demonstrated that IV albumin (1.5 g/kg body weight on day 1 and 1 g/kg on day 3) significantly reduced the incidence of hepatorenal syndrome (from 33% to 10%) and improved 3-month survival in cirrhotic patients with SBP compared to cefotaxime alone. The mechanism is that SBP-induced cytokine release causes splanchnic vasodilation and reduced effective arterial blood volume, precipitating HRS; albumin expands plasma volume and has anti-inflammatory properties. This is now standard of care (EASL 2018 guidelines). Midodrine+octreotide is used for established Type 1 HRS. FFP is not indicated for SBP management.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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