Albumin May Prevent the Morbidity of Paracentesis-Induced Circulatory Dysfunction in Cirrhosis and Refractory Ascites: A Pilot Study

• Published in: Digestive diseases and sciences Vol. 61; no. 10; pp. 3084 - 3092
• Main Authors: Tan, Hiang Keat, James, Paul Damien, Wong, Florence
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2016; Springer; Springer Nature B.V
• Subjects: Administration, Intravenous; Aged; Albumin; Albumins - therapeutic use; Aldosterone; Aldosterone - blood; Angiotensin II - blood; Aprotinin; Ascites; Ascites - etiology; Ascites - therapy; Biochemistry; Cardiovascular Diseases - blood; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Cardiovascular Diseases - prevention & control; Diabetes Mellitus - epidemiology; Female; Gastroenterology; Hepatology; Humans; Liver; Liver cirrhosis; Liver Cirrhosis - complications; Liver Transplantation; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Neurohormones; Norepinephrine - blood; Odds Ratio; Oncology; Original Article; Paracentesis - adverse effects; Paracentesis - methods; Pilot Projects; Pneumoviridae; Portasystemic Shunt, Transjugular Intrahepatic; Renin - blood; Risk Factors; Transplant Surgery; Transplantation of organs, tissues, etc; Cirrhosis; Large-volume paracentesis; Paracentesis-induced circulatory dysfunction; Ascites; Renal failure
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-016-4140-3

Background Large-volume total paracentesis may result in paracentesis-induced circulatory dysfunction, which is associated with poor outcomes. Aims To explore the short- and long-term effects of paracentesis-induced circulatory dysfunction on systemic hemodynamics, renal function and other cirrhosis-related complications in patients with refractory ascites, following subtotal large-volume paracentesis. Methods Patients with cirrhosis and refractory ascites without renal dysfunction had systemic hemodynamics, renal function, and neurohormones (plasma active renin, aldosterone, norepinephrine and angiotensin II) measured pre- and 6 days post-paracentesis. Paracentesis was limited to ≤8 L with 6–8 g of albumin per liter ascites drained. Patients were followed up until transjugular intrahepatic portosystemic shunt insertion, liver transplantation, or death. Paracentesis-induced circulatory dysfunction was defined as >50 % increase in plasma active renin 6 days post-paracentesis. Results Fifty-seven patients (mean age 59.0 ± 9.4 years) had mean 6.8 ± 1.8 L of ascites removed with 9 ± 3 g of albumin given/L of ascites drained. Patients were followed up for 715 ± 104 days. Twenty-three patients (40.4 %) developed paracentesis-induced circulatory dysfunction with unchanged serum creatinine on day six, despite worsening of hemodynamics (mean arterial pressure 90 ± 10 mmHg at baseline vs. 84 ± 8 mmHg on day six, p  < 0.05). Similar hemodynamic changes were observed among patients without paracentesis-induced circulatory dysfunction. There was no significant difference in the long-term renal function or cirrhosis-related complications between the groups. Conclusion The occurrence of paracentesis-induced circulatory dysfunction, as defined by plasma active renin, may not have a significant short- and long-term impact on renal function or cirrhosis-related complications in patients with refractory ascites who undergo subtotal paracentesis with albumin infusion.