García-Compean D, Blanc P, Larrey D, Jean-Pierre D, Hirtz J, Mendoza E, Maldonado H, Michel H

Language: English
References: 24
Page: 29-35
PDF size: 146.01 Kb.

Text Extraction

Intravenous albumin infusion prevents complications after large-volume paracentesis (LVP), particularly paracentesis-induced circulatory dysfunction (PCD), and improves patient survival. However, albumin is expensive. We compared a low-molecular weight dextran (Dextran-40) with albumin in treating LVP in cirrhotic patients with tense ascites. Sixty-nine cirrhotic patients were included and 96 LVPs were performed. Any repeat punctures on the same patient were at least three months apart. Patients were randomized to receive either i.v. Dextran-40 infusion (Group I, n = 48) or i.v. albumin infusion after LVP (Group II, n = 48). Clinical, biochemical, and hormonal evaluations were done before and after LVP. Patients were followed up for the detection of any recurrence of ascites or complications.The two groups were similar in age, sex, and etiology of cirrhosis, and in the volumes of ascites recovered. Significant decreases in mean arterial pressure were observed in both groups 24 and 48 h after LVP. Urine volumes increased significantly at 24 h in both groups (p ‹ 0.05), but remained high only in Group I. Plasma renin activity and aldosterone concentrations increased in both groups 48 h after LVP, but they were more marked in Group I. Complications developed in 17 % of patients treated with Dextran-40 and in 23 % treated with albumin (p › 0.05). Ascites recurrence rates and survival were similar in the two groups. In conclusion, Dextran-40 was thus not as efficacious as albumin for preventing PCD.

REFERENCES

1. Gines P, Arroyo V. Paracentesis in the management of cirrhotic ascites. J Hepatol 1993;17(Suppl 2):S14–18.

2. Tito L, Gines P, Arroyo V, Planas R, Panes J, Rimola A, et al. Total paracentesis associated with intravenous albumin in the management of patients with cirrhosis and ascites. Gastroenterology 1990;98:146–151.

3. Garcia-Compean D, Zacarias-Villarreal J, Bahena H, Garcia-Cantu DA, Estrella M, Garza-Tamez E et al. Total therapeutic paracentesis (TTP) with and without intravenous albumin in the treatment of cirrhotic tense ascites: a randomized controlled trial. Liver 1993;13:233–238.

4. Quintero E, Gines P, Arroyo V, Rimola A, Bory F, Blanas R et al. Paracentesis vs. diuretics in the treatment of cirrhotics with tense ascites. Lancet 1985;1:611–612.

5. Gines E, Arroyo V, Quintero E, Planas R, Bory F, Cabrera J et al. Comparison of paracentesis and diuretics in the treatment of cirrhotics with tense ascites. Gastroenterology 1987;93:234–241.

6. Salerno F, Badalamenti S, Incerti P, Tempini S, Restelli B, Bruno S et al. Repeated paracentesis and IV albumin infusion to treat tense ascites in cirrhotic patients: a safe alternative therapy. J Hepatol 1987;5:102–108.

7. Gines P, Tito L, Arroyo V, Planas R, Panes J, Viver J et al. Randomized comparative study of therapeutic paracentesis with and without intravenous albumin in cirrhosis. Gastroenterology 1988;94:1493–1502.

8. Gines A, Fernandes-Esparrach G, Monescillo A, Vila C, Domenech E, et al. Randomized trial comparing albumin, Dextran 70, and Polygeline in cirrhotic patients with ascites treated by paracentesis. Gastroenterology 1996;111:1002–1010.

9. Menard J, Catt KJ. Measurement of renin activity, concentration and substrate in rat plasma by radioimmunoassay of angiotensin I. Endocrinology 1972;90:422–430.

10. Balikian HM, Brodie AH, Dale SL, Meiby JL, Tait JF. Effect of posture on the metabolic clearance rate, plasma concentration and blood production rate of aldosterone in man. J Clin Endocrinol Metab 1968; 28: 1630–1640.

11. Lieberman FL, Reynolds TB. Plasma volume in cirrhosis of the liver: its relation to portal hypertension, ascites and renal failure. J Clin Invest 1967;46:1297–1308.

12. Dixon WJ (ed.) BMDP statistical software. Berkeley CA: University of California Press, 1985.

13. Antillon MR, Runyon BA. Post-paracentesis plasma expansion prevents asymptomatic laboratory abnormalities, but does it have any impact on morbidity and mortality? Gastroenterology 1991;10:1455–1457.

14. Kao HW, Rakov NE, Savage E, Reynolds TB. The effect of large volume paracentesis on plasma volume - a cause of hypovolemia? Hepatology 1985;5:403–407.

15. Pinto PC, Amerian J, Reynolds TB. Large volume paracentesis in non edematous patients with tense ascites. Its effect on intravascular volume. Hepatology 1988;8:207–210.

16. Panos MZ, Moore K, Vlavianos P, Chambers JB, Anderson JV, Gimson DES, et al. Single total paracentesis for tense ascites: sequential hemodynamic and right atrial size. Hepatology 1990;11:662–667.

17. Simon DM, McCain JR, Bonkowsky HL, Wells JO, Hartle PK, Galambos JT. Effects of therapeutic paracentesis on systemic and hepatic hemodynamics and on renal and hormonal function. Hepatology 1987;7:423–429.

18. Brackmann HH, Egli H. Acute hepatitis B infection after treatment with heat- inactivated factor VIII concentrate (Letter). Lancet 1988;2:967.

19. Salerno F, Badalamenti S, Lorenzano E, Moser P, Incerti P. Randomized comparative study of haemacel vs. albumin infusion after total paracentesis in cirrhotic patients with refractory ascites. Hepatology 1991;13:707–713.

20. Acharya SK, Baldwinder S, Badhee AK, Nijhawan S, Tandon BN. Large volume paracentesis and intravenous dextran to treat tense ascites. J Clin Gastroenterol 1992;14:31–35.

21. Planas R, Gines P, Arroyo V, LLach J, Panes J, Vargas V et al. Dextran-70 versus albumin as plasma expanders in cirrhotic patients with tense ascites treated with total paracentesis. Results of a randomized study. Gastroenterology 1990;99:1736–1744.

22. Dewatcher P, Laxenaire MC, Donner M, Kurtz M, Stoltz JF. Effets rhéologiques in vivo des substituts plasmatiques. Ann Fr Anesth Reanim 1992;11:516–525.

23. Kohler H, Zschiedrich H, Linfante A, Clasen R. Elimination of hydroxyethyl starch 200/0.5, dextran-40 and oxypolygelatin. Klin Wochenschr 1982;60:293–301.

24. Ruiz L, Monescillo A, Jimenez W, Garcia A, Arroyo V, Rodes J. Paracentesis-induced circulatory dysfunction: Mechanism and effect on hepatic hemodynamics in cirrhosis. Gastroenterology 1997;113:579–586.