The impact of paracentesis flow rate in patients with liver cirrhosis on the development of paracentesis induced circulatory dysfunction
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Background/Aims: Ascites is a dreadful complication of liver cirrhosis associated with short survival. Large volume paracentesis (LVP) is used to treat tense or refractory ascites. Paracentesis induced circulatory dysfunction (PICD) develops if no plasma expanders are given with ominous complications. To study the effect of ascites flow rate on PICD development. Methods: Sixty patients with cirrhosis and tense ascites underwent LVP of 8 L were randomized into 3 equal groups of different flow rate extraction; group I (80 mL/minute), group II (180 mL/minute) and group III (270 mL/minute). Plasma renin activity (PRA) was measured baseline and on day six. PICD was defined as increase in PRA >50% of the pretreatment value. Results: In group I through 3; the mean age was (52.5±9.4 vs. 56.4±8.5 vs. 55.8±7.1 years; P>0.05), mean arterial pressure (81.4±5.6 vs. 81.5±7 vs. 79.5±7.2 mmHg; P>0.05), MELD (17.6±4.1 vs. 15.8±4.1 vs. 14.7±4.5). Baseline PRA was comparable (1,366.0±1244.9 vs. 1,151.3±1,444.8 vs. 951.9±1,088 pg/mL; P>0.05). There was no statistically significant (P>0.05) flow mediated changes (Δ) of creatinine (0.23±0.27 vs. 0.38±0.33 vs. 0.26±0.18 mg/dL), MELD (1.25±5.72 vs. 1.70±2.18 vs. 1.45±2.21) or PRA (450.93±614.10 vs. 394.61±954.64 vs. 629.51±1,116.46 pg/mL). PICD was detected in a similar frequency in the three groups (P>0.05). On univariate logistic analysis only female sex was a fairly significant PICD predictor (Wald 3.85, odds ratio 3.14; P=0.05). Conclusions: The ascites flow rate does not correlate with PICD development.
Abstract
Background/Aims: Ascites is a dreadful complication of liver cirrhosis associated with short survival. Large volume paracentesis (LVP) is used to treat tense or refractory ascites. Paracentesis induced circulatory dysfunction (PICD) develops if no plasma expanders are given with ominous complications. To study the effect of ascites flow rate on PICD development. Methods: Sixty patients with cirrhosis and tense ascites underwent LVP of 8 L were randomized into 3 equal groups of different flow rate extraction; group I (80 mL/minute), group II (180 mL/minute) and group III (270 mL/minute). Plasma renin activity (PRA) was measured baseline and on day six. PICD was defined as increase in PRA >50% of the pretreatment value. Results: In group I through 3; the mean age was (52.5±9.4 vs. 56.4±8.5 vs. 55.8±7.1 years; P>0.05), mean arterial pressure (81.4±5.6 vs. 81.5±7 vs. 79.5±7.2 mmHg; P>0.05), MELD (17.6±4.1 vs. 15.8±4.1 vs. 14.7±4.5). Baseline PRA was comparable (1,366.0±1244.9 vs. 1,151.3±1,444.8 vs. 951.9±1,088 pg/mL; P>0.05). There was no statistically significant (P>0.05) flow mediated changes (Δ) of creatinine (0.23±0.27 vs. 0.38±0.33 vs. 0.26±0.18 mg/dL), MELD (1.25±5.72 vs. 1.70±2.18 vs. 1.45±2.21) or PRA (450.93±614.10 vs. 394.61±954.64 vs. 629.51±1,116.46 pg/mL). PICD was detected in a similar frequency in the three groups (P>0.05). On univariate logistic analysis only female sex was a fairly significant PICD predictor (Wald 3.85, odds ratio 3.14; P=0.05). Conclusions: The ascites flow rate does not correlate with PICD development.
참고문헌 (37)
- Kuiper JJ, "Review article: Management of ascites and associated complications in patients with cirrhosis", Aliment Pharmacol Ther, 26(2), pp.183~193 (2007)
- Kuiper JJ, "Ascites in cirrhosis : a review of management and complications", Neth J Med, 65, pp.283~288 (2007)
- Hou W, "Ascites: diagnosis and management", Med Clin North Am, 93, pp.801~817 (2009)
- Runyon BA, "Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012", Hepatology, 57, pp.1651~1653 (2013)
- European Association for the Study of the Liver, "EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis", J Hepatol, 53, pp.397~417 (2010)
- Runyon BA, "Management of adult patients with ascites due to cirrhosis : an update", Hepatology, 49, pp.2087~2107 (2009)
- Lindsay AJ, "Paracentesis-induced circulatory dysfunction : a primer for the interventional radiologist", Semin Intervent Radiol, 31, pp.276~278 (2014)
- Moore KP, "Guidelines on the management of ascites in cirrhosis", Gut, 55(6), pp.1~12 (2006)
- Ruiz-del-Arbol L, "Paracentesis-induced circulatory dysfunction : mechanism and effect on hepatic hemodynamics in cirrhosis", Gastroenterology, 113, pp.579~586 (1997)
- Alessandria C, "Prevention of paracentesis-induced circulatory dysfunction in cirrhosis: standard vs half albumin doses. A prospective, randomized, unblinded pilot study", Dig Liver Dis, 43, pp.881~886 (2011)
- Alsebaey A, "Prevention of paracentesis-induced circulatory dysfunction: could we use other albumin alternatives?", Egyptian Liver J, 3, pp.118~125 (2013)
- Moreau R, "Comparison of the effect of terlipressin and albumin on arterial blood volume in patients with cirrhosis and tense ascites treated by paracentesis : a randomised pilot study", Gut, 50, pp.90~94 (2002)
- Singh V, "Terlipressin versus albumin in paracentesis-induced circulatory dysfunction in cirrhosis : a randomized study", J Gastroenterol Hepatol, 21, pp.303~307 (2006)
- Lata J, "The efficacy of terlipressin in comparison with albumin in the prevention of circulatory changes after the paracentesis of tense ascites--a randomized multicentric study", Hepatogastroenterology, 54, pp.1930~1933 (2007)
- Abdullah MH, "Terlipressin versus norepinephrine to counteract intraoperative paracentesis induced refractory hypotension in cirrhotic patients", Egyptian J Anaesthesia, 1, pp.29~35 (2012)
- Singh V, "Noradrenaline and albumin in paracentesis-induced circulatory dysfunction in cirrhosis : a randomized pilot study", J Intern Med, 260, pp.62~68 (2006)
- Singh V, "Midodrine versus albumin in the prevention of paracentesis induced circulatory dysfunction in cirrhotics : a randomized pilot study", Am J Gastroenterol, 103, pp.1399~1405 (2008)
- Appenrodt B, "Prevention of paracentesis-induced circulatory dysfunction: midodrine vs albumin. A randomized pilot study", Liver Int, 28, pp.1019~1025 (2008)
- Hamdy H, "Comparison of midodrine and albumin in the prevention of paracentesis-induced circulatory dysfunction in cirrhotic patients : a randomized pilot study", J Clin Gastroenterol, 48, pp.184~188 (2014)
- Planas R, "Dextran-70 versus albumin as plasma expanders in cirrhotic patients with tense ascites treated with total paracentesis. Results of a randomized study", Gastroenterology, 99, pp.1736~1744 (1990)
- Ginès A, "Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis", Gastroenterology, 111, pp.1002~1010 (1996)
- García-Compean D, "Treatment of cirrhotic tense ascites with Dextran-40 versus albumin associated with large volume paracentesis : a randomized controlled trial", Ann Hepatol, 1, pp.29~35 (2002)
- Moreau R, "Comparison of outcome in patients with cirrhosis and ascites following treatment with albumin or a synthetic colloid : a randomised controlled pilot trail", Liver Int, 26, pp.46~54 (2006)
- El-Ashry N, "Large volume abdominal paracentesis effect on some humoral factors and cardiac performance in patients with liver cirrhosis and tense ascities", J Egypt Soc Parasitol, 37, pp.571~584 (2007)
- Abdel-Khalek EE, "Ran{Runyon, 2009 #66}{Runyon, 2009#66}{Runyon, 2009 #66}domized trial comparing human albumin and hydroxyethyl starch 6% as plasma expanders for treatment of patients with liver cirrhosis and tense ascites following large volume paracentesis", Arab Journal of Gastroenterology, 11, pp.24~29 (2010)
- Nasr G, "Predictors of large volume paracantesis induced circulatory dysfunction in patients with massive hepatic ascites", J Cardiovasc Dis Res, 1, pp.136~144 (2010)
- Cabrera J, "Large-volume paracentesis and intravenous saline : effects on the renin-angiotensin system", Hepatology, 14, pp.1025~1028 (1991)
- Sola-Vera J, "Randomized trial comparing albumin and saline in the prevention of paracentesis-induced circulatory dysfunction in cirrhotic patients with ascites", Hepatology, 37, pp.1147~1153 (2003)
- Sersté T, "Deleterious effects of beta-blockers on survival in patients with cirrhosis and refractory ascites", Hepatology, 52, pp.1017~1022 (2010)
- Sersté T1, "Beta-blockers cause paracentesis-induced circulatory dysfunction in patients with cirrhosis and refractory ascites : a cross-over study", J Hepatol, 55, pp.794~799 (2011)
- Schuppan D, "Liver cirrhosis", Lancet, 371, pp.838~851 (2008)
- Rimola A, "Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document", J Hepatol, 32, pp.142~153 (2000)
- McGibbon A, "An evidencebased manual for abdominal paracentesis", Dig Dis Sci, 52, pp.3307~3315 (2007)
- Cabrera J, "Abdominal decompression plays a major role in early postparacentesis haemodynamic changes in cirrhotic patients with tense ascites", Gut, 48, pp.384~389 (2001)
- Coll S, "Mechanisms of early decrease in systemic vascular resistance after total paracentesis : influence of flow rate of ascites extraction", Eur J Gastroenterol Hepatol, 16, pp.347~353 (2004)
- Carl DE, "Postparacentesis circulatory derangements are related to monocyte activation", Liver Int, 34, pp.1001~1007 (2014)
- Johnson KB, "Reduced Albumin Dosing During Large-Volume Paracentesis Is Not Associated with Adverse Clinical Outcomes", Dig Dis Sci, 60, pp.2190~2195 (2015)