[Efficacy and safety of large volume paracentesis in cirrhotic patients with spontaneous bacterial peritonitis: a randomized prospective study].
OBJECTIVE
Large volume paracentesis (LVP) associated with plasma volume expansion is known to be an effective and safe therapy for tense or refractory ascites in cirrhosis. Spontaneous bacterial peritonitis (SBP) is one of the frequent infections in patients with cirrhosis. We conducted a study to assess the efficacy and safety of large volume paracentesis in cirrhotic patients with SBP.


METHODS
We randomly assigned 40 patients with cirrhosis and SBP to either treatment with LVP (21 patients) or general management (19 patients). LVP was defined as drainage of ascitic fluid of more than 4 liters in a single tap or loss of shifting dullness after paracentesis. LVP was performed within 48 hours after the diagnosis of SBP in the LVP group. Cefotaxime was given daily in doses that varied according to the serum creatinine level in both groups. Albumin was given at a dose of 6-8 g per 1 liter of removed ascites in the LVP group.


RESULTS
After seven days of treatments, the blood chemistry test, and WBC (PMN) counts and protein concentration in the ascitic fluid were not different between the two groups. Among them, the WBC (PMN) counts were decreased significantly in both groups and protein concentrations tended to increase. Durations of abdominal tenderness and pain were shorter in the LVP group but the differences were statistically not significant. Admission periods, resolution rates of SBP after seven days of treatment, complication rates and in-hospital mortality rates were not different between the two groups.


CONCLUSIONS
The two treatment methods demonstrated almost the same effectiveness and safety. The symptoms were improved slightly faster in the LVP group. We concluded that large volume paracentesis is not an absolute contraindication and can be a tolerable and safe therapy in some selected cirrhotic patients with tense ascites and SBP.
Choi
Chang Hwan
CH
Department of Internal Medicine, Gastroenterology division, Yonsei University College of Medicine, Seoul, Korea. gihankhys@yumc.yonsei.ac.kr
Han
Kwang Hyub
KH
Kim
Do Young
DY
Cho
Jae Hee
JH
Cheong
Jae Youn
JY
Song
Kun Hoon
KH
Chon
Chae Yoon
CY
Moon
Young Myoung
YM
D000328:Adult; D000368:Aged; D001201:Ascites / Q000209:etiology / Q000628:therapy*; D001424:Bacterial Infections / Q000150:complications*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000379:methods; D010538:Peritonitis / Q000150:complications / Q000382:microbiology / Q000628:therapy*; D010952:Plasma Substitutes / Q000008:administration & dosage; D011446:Prospective Studies
D010952:Plasma Substitutes