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Paracentesis‐Induced Circulatory Dysfunction With Modest‐Volume Paracentesis Is Partly Ameliorated by Albumin Infusion in Acute‐on‐Chronic Liver Failure
Author(s) -
Arora Vinod,
Vijayaraghavan Rajan,
Maiwall Rakhi,
Sahney Amrish,
Thomas Sherin Sarah,
Ali Rehmat,
Jain Priyanka,
Kumar Guresh,
Sarin Shiv Kumar
Publication year - 2020
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.31071
Subject(s) - medicine , paracentesis , cirrhosis , hyponatremia , gastroenterology , albumin , plasma renin activity , ascites , renin–angiotensin system , blood pressure
Background and Aims Paracentesis‐induced circulatory dysfunction (PICD) is a serious complication of large‐volume (>5 L) paracentesis in cirrhosis and is reduced with albumin infusion. There is a lack of data on PICD in acute‐on‐chronic liver failure (ACLF). Because ACLF patients have greater hemodynamic derangements than patients with decompensated cirrhosis, we investigated whether PICD could develop with modest‐volume paracentesis (MVP) and the role of albumin infusion. Approach and Results A total of 80 ACLF patients undergoing <5 L paracentesis were randomized to receive albumin (8 g/dL of ascitic fluid; n = 40) or no albumin (n = 40) and serially followed to detect PICD. Baseline characteristics were comparable between groups, including volume of ascitic tap (4.16 ± 0.23 versus 4.14 ± 0.27 L; P = 0.72) and plasma renin activity (PRA; 20.5 ± 7.03 versus 23.2 ± 8.24 ng/mL/hour; P = 0.12). PICD was more frequent in the no‐albumin group than the albumin group (70% versus 30%; P = 0.001), with higher incidence of hepatic encephalopathy (50% versus 27.5%; P = 0.04), hyponatremia (67.5% versus 22.5%; P < 0.001), acute kidney injury (62.5% versus 30%; P = 0.001), and in‐house mortality (62.5% versus 27.5%; P = 0.003). PRA of 25.15 ng/mL at day 3 had sensitivity and specificity of 71% and 68%, respectively, for development of PICD at day 6. Albumin infusion decreased the incidence of PICD at day 6 (odds ratio, 0.068; 95% confidence interval, 0.011‐0.43; P = 0.005). Conclusions PICD is common and develops even with MVP in ACLF patients. Albumin infusion decreases the incidence of PICD and mortality in patients with ACLF. Clinical trial identifier: NCT02467348