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Post‐paracentesis circulatory derangements are related to monocyte activation
Author(s) -
Carl Daniel E.,
Ghosh Siddharta,
Cheng Jianfeng,
Gehr Todd W. B.,
Stravitz R. Todd,
Sanyal Arun
Publication year - 2014
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12450
Subject(s) - medicine , paracentesis , blood pressure , mean arterial pressure , monocyte , circulatory system , creatinine , pulse pressure , endocrinology , cardiology , heart rate , ascites
Background & Aims Post‐paracentesis circulatory dysfunction is associated with development of hepatorenal syndrome and increased mortality. The impact of large volume paracentesis ( LVP ) on the 24‐h blood pressure ( BP ) profile is unknown, and the relationship to Na + ‐retentive and pro‐inflammatory cytokines also remains unknown. The aims of this study were to (i) define the effects of LVP with albumin administration on 24‐h BP profiles, and (ii) relate changes in BP over time to changes in Na + ‐retentive hormones, clinical factors and inflammatory cytokines. Methods Ten patients undergoing LVP had 24‐h ambulatory BP monitoring performed pre‐ and post‐paracentesis. Markers of the innate immune system, bacterial translocation and Na + ‐retentive hormones were drawn pre‐ and post‐ LVP . Results Mean arterial pressure ( MAP ) dropped in nine of the 10 patients in the 24 h following a paracentesis compared to 24 h preceding the procedure (mean drop of 5.5 mmHg, P < 0.005). A mixed effects model was used to define time‐covariate interactions in predicting changes in BP profile. Monocyte chemotactic protein‐1 ( MCP 1) was associated with Δsystolic BP (β = −0.011, P < 0.05), Δdiastolic BP (β = −0.012, P < 0.05) and Δ MAP (β = −0.012, P < 0.05). Plasma renin activity was also significantly associated with Δsystolic BP (β = −0.21, P < 0.05). Renal function was also significantly reduced following LVP . Conclusions Systolic, diastolic and MAP decreased over 24 h after LVP compared to the 24 h pre‐ LVP . This drop is related to increases in MCP ‐1 after LVP . Increased MCP ‐1, a marker of monocyte activation, was strongly related to changes in BP .