Long-term clinical outcome of large volume paracentesis with intravenous albumin in patients with spontaneous bacterial peritonitis: a randomized prospective study.
OBJECTIVE
Large volume paracentesis (LVP) with plasma volume expansion has been used for tense or refractory ascites. However, still in question is whether it is safe and effective for the treatment of spontaneous bacterial peritonitis (SBP). We addressed this issue and conducted a study to assess safety and long-term outcome of LVP in cirrhotic patients with SBP.


METHODS
Forty-two randomly assigned cirrhotic patients with SBP were classified into two groups; Group 1 included 21 patients who were treated with LVP and intravenous albumin; and Group 2 included 21 patients who were treated with diuretics and intravenous albumin.


RESULTS
The overall cumulative survival rate was poor in patients with SBP (42.5% and 22.5% at 6 and 12 months, respectively). At 7 days after treatment, the blood tests were similar between the two groups. In the ascitic fluid, the white blood cell counts decreased significantly and the protein concentrations tended to increase in both groups. In-hospital days, resolution rate of SBP, and in-hospital mortality rate were similar between the two groups. Although complication rates tended to be slightly higher in Group 1, long-term cumulative survivals were similar between Group 1 and Group 2. LVP was effective in removing abdominal discomfort in patients with tense ascites without serious complication.


CONCLUSIONS
LVP with intravenous albumin was as effective as diuretics with intravenous albumin for the treatment of SBP with similar mortality. LVP with intravenous albumin might be feasible for the treatment of tense or refractory ascites in cirrhotic patients with SBP.
Choi
Chang Hwan
CH
Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, Korea.
Ahn
Sang Hoon
SH
Kim
Do Young
DY
Lee
Sang Kil
SK
Park
Jeong Youp
JY
Chon
Chae Yoon
CY
Moon
Young Myoung
YM
Han
Kwang-Hyub
KH
D000418:Albumins / Q000008:administration & dosage; D001201:Ascites / Q000382:microbiology / Q000517:prevention & control / Q000628:therapy; D001424:Bacterial Infections / Q000382:microbiology / Q000517:prevention & control / Q000628:therapy*; D002423:Cause of Death; D003131:Combined Modality Therapy; D004232:Diuretics / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000009:adverse effects / Q000379:methods*; D010538:Peritonitis / Q000382:microbiology / Q000517:prevention & control / Q000628:therapy*; D011446:Prospective Studies; D055502:Secondary Prevention; D016019:Survival Analysis; D016896:Treatment Outcome
D000418:Albumins; D004232:Diuretics