Terlipressin versus albumin in paracentesis-induced circulatory dysfunction in cirrhosis: a randomized study.
BACKGROUND
Therapeutic paracentesis in patients with cirrhosis induces arterial vasodilatation, causes a decrease in effective arterial blood volume and leads to circulatory dysfunction, which can be prevented by intravenous albumin. However, the use of albumin, being a blood product, is controversial. Recently, terlipressin, a vasoconstrictor, has been successfully used to combat this adverse effect of therapeutic paracentesis. Therefore, the aim of the present study was to investigate the preventive effect of terlipressin on paracentesis-induced circulatory dysfunction in patients with cirrhosis after therapeutic paracentesis and compared with that of intravenous albumin.


METHODS
Forty patients with cirrhosis and tense ascites underwent therapeutic paracentesis with albumin or terlipressin in a randomized pilot study at a tertiary center. Effective arterial blood volume was assessed by measuring plasma renin activity at baseline and at 4-6 days after treatment.


RESULTS
Effective arterial blood volumes as indicated by plasma renin activity before and 4-6 days after paracentesis did not differ in the two groups (19.15 +/- 12.1 to 20.33 +/- 12.8 ng/mL per h, P = 0.46 in the albumin group; and 20.11 +/- 10.6 to 21.08 +/- 10.52 ng/mL per h, P = 0.44 in the terlipressin group). Plasma aldosterone concentrations before and 4-6 days after paracentesis were also similar in both groups (1334.75 +/- 1058 to 1440.0 +/- 1161 pg/mL, P = 0.06 in the albumin group; and 1473.0 +/- 1168 to 1572.29 +/- 1182 pg/mL, P = 0.24 in the terlipressin group). Both terlipressin and albumin prevented paracentesis-induced renal impairment in these patients.


CONCLUSIONS
Terlipressin may be as effective as intravenous albumin in preventing paracentesis-induced circulatory dysfunction in patients with cirrhosis after therapeutic paracentesis.
Singh
Virendra
V
Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. virendrasingh100@hotmail.com
Kumar
Ramesh
R
Nain
Chander Kanwal
CK
Singh
Baljinder
B
Sharma
Arun K
AK
D000418:Albumins / Q000627:therapeutic use*; D000450:Aldosterone / Q000097:blood; D001201:Ascites / Q000209:etiology / Q000628:therapy*; D001810:Blood Volume; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000009:adverse effects*; D010952:Plasma Substitutes / Q000627:therapeutic use*; D012083:Renin / Q000097:blood; D000077585:Terlipressin; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D000418:Albumins; D010952:Plasma Substitutes; D014662:Vasoconstrictor Agents; D000450:Aldosterone; D008236:Lypressin; D000077585:Terlipressin; D012083:Renin