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The relationship between portal pressure and plasma albumin in the development of cirrhotic ascites
Author(s) -
WOOD L. J.,
COLMAN J.,
DUDLEY F. J.
Publication year - 1987
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.1987.tb00200.x
Subject(s) - ascites , medicine , oncotic pressure , albumin , cirrhosis , paracentesis , portal hypertension , gastroenterology , portal venous pressure , endocrinology
Ascites develops as a result of avid renal sodium retention together with an imbalance of Starling's equilibrium at the level of the hepatic sinusoid and mesenteric capillary. This study aimed to examine the effect of the imbalance between portal pressure, measured as corrected wedged hepatic vein pressure (cWHVP) and plasma oncotic pressure, measured as plasma albumin on the development of cirrhotic ascites. Fifty‐two patients with biopsy‐proven alcoholic cirrhosis were studied on 72 separate occasions. The absence of ascites was determined by the combination of lack of signs of free intraperitoneal fluid and normal prothrombin time in patients not receiving diuretics. If signs of free intraperitoneal fluid were found, the presence of ascites was confirmed by ultrasonography or diagnostic paracentesis and graded clinically as mild, moderate or severe. Ascites tended to occur with a cWHVP > 15 mmHg and plasma albumin < 35 g/l, but there was a large overlap in values between patients with and without ascites. When plasma albumin was plotted against cWHVP a clear line of separation between the presence or absence of ascites could be obtained. The equation of the line was: Plasma albumin (g/l) ‐ 16 = 1.23 cWHVP (mmHg). Ascites was present in all patients with [Plasma albumin ‐ 16]/cWHVP < 1.23. There was no significant difference in plasma albumin, cWHVP or [Plasma albumin ‐ 16]/cWHVP between patients with mild, moderate or severe ascites. If [Plasma albumin ‐ 16]/cWHVP was > 1.23, ascites was not clinically detectable and these patients no longer required diuretics. The clinical applicability of this ratio was assessed in 16 patients who had no detectable ascites but who were still receiving diuretics. In all 10 patients with a ratio > 1.23 diuretics were ceased without reaccumulation of ascites. Thus this ratio may be used to predict when patients no longer require diuretic therapy.