title: Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis.
abstract: OBJECTIVE
  Paracentesis associated with plasma expanders is widely used for the treatment of ascites in cirrhosis. This study investigated the clinical importance of paracentesis-induced-circulatory dysfunction and compared the efficacy of albumin, dextran 70, and polygeline in preventing this complication.
  
  
  METHODS
  A total of 289 cirrhotic patients with ascites were randomized to treatment by total paracentesis plus intravenous albumin (97 patients), dextran 70 (93 patients), or polygeline (99 patients). Postparacentesis circulatory dysfunction was defined as an increase in plasma renin activity on the sixth day after paracentesis of more than 50% of the pretreatment value to a level > 4 ng.mL-1.h-1.
  
  
  RESULTS
  Postparacentesis circulatory dysfunction occurred more frequently in patients treated with dextran 70 (34.4%; P = 0.018) or polygeline (37.8%; P = 0.004) than in those receiving albumin (18.5%). The plasma expander used and the volume of ascites removed were independent predictors of this complication. Postparacentesis circulatory dysfunction persisted during follow-up and was associated with a shorter time to first readmission (1.3 +/- 0.5 vs. 3.5 +/- 0.8 months, median +/- SEM; P = 0.03) and shorter survival (9.3 +/- 4.2 vs. 16.9 +/- 4.3 months; P = 0.01). Creatinine and sodium levels in serum, and Child-Pugh score at inclusion, and postparacentesis circulatory dysfunction were independent predictors of survival.
  
  
  CONCLUSIONS
  Postparacentesis circulatory dysfunction is not spontaneously reversible and is associated with a shorter time to first readmission and shorter survival. Albumin is the best plasma expander to prevent this complication.
authors.affiliation: Liver Unit, Hospital Clinic i Provincial, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Ginès
authors.forename: G
authors.initials: G
authors.lastname: Fernández-Esparrach
authors.forename: A
authors.initials: A
authors.lastname: Monescillo
authors.forename: C
authors.initials: C
authors.lastname: Vila
authors.forename: E
authors.initials: E
authors.lastname: Domènech
authors.forename: R
authors.initials: R
authors.lastname: Abecasis
authors.forename: P
authors.initials: P
authors.lastname: Angeli
authors.forename: L
authors.initials: L
authors.lastname: Ruiz-Del-Arbol
authors.forename: R
authors.initials: R
authors.lastname: Planas
authors.forename: R
authors.initials: R
authors.lastname: Solà
authors.forename: P
authors.initials: P
authors.lastname: Ginès
authors.forename: R
authors.initials: R
authors.lastname: Terg
authors.forename: L
authors.initials: L
authors.lastname: Inglada
authors.forename: P
authors.initials: P
authors.lastname: Vaqué
authors.forename: F
authors.initials: F
authors.lastname: Salerno
authors.forename: V
authors.initials: V
authors.lastname: Vargas
authors.forename: G
authors.initials: G
authors.lastname: Clemente
authors.forename: J C
authors.initials: JC
authors.lastname: Quer
authors.forename: W
authors.initials: W
authors.lastname: Jiménez
authors.forename: V
authors.initials: V
authors.lastname: Arroyo
authors.forename: J
authors.initials: J
authors.lastname: Rodés
mesh_terms: D000328:Adult; D000368:Aged; D000418:Albumins / Q000627:therapeutic use*; D001201:Ascites / Q000401:mortality / Q000628:therapy; D001775:Blood Circulation / Q000187:drug effects*; D003911:Dextrans / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000009:adverse effects*; D011097:Polygeline / Q000627:therapeutic use*; D012083:Renin / Q000097:blood
chemical_list: D000418:Albumins; D003911:Dextrans; D011097:Polygeline; D012083:Renin