Noradrenaline and albumin in paracentesis-induced circulatory dysfunction in cirrhosis: a randomized pilot study.
OBJECTIVE
Therapeutic paracentesis in patients with cirrhosis is associated with a circulatory dysfunction. Intravenous albumin has been used to prevent the circulatory dysfunction; however, the use of albumin is controversial and costly. Splanchnic vasodilation is mainly responsible for circulatory dysfunction in these patients. There are no reports of use of noradrenaline, a vasoconstrictor, on the prevention of paracentesis-induced circulatory dysfunction in patients with cirrhosis. Therefore, we studied the preventive effect of noradrenaline on paracentesis-induced circulatory dysfunction in patients with cirrhosis after therapeutic paracentesis and compared it with that of intravenous albumin in a randomized pilot study.


METHODS
Forty patients with cirrhosis and tense ascites underwent therapeutic paracentesis with albumin or noradrenaline in a randomized controlled trial at a tertiary centre. Effective arterial blood volume was assessed by measuring plasma renin activity at baseline and at 6 days after treatment.


RESULTS
Effective arterial blood volume as indicated by plasma renin activity before and 6 days after paracentesis did not differ in the two groups (20.62 +/- 10.27-22.02 +/- 10.15 ng mL(-1) h(-1); P = 0.11 in the albumin group and 19.66 +/- 8.91-20.78 +/- 9.41 ng mL(-1) h(-1); P = 0.37 in the noradrenaline group). Plasma aldosterone concentration before and 6 days after paracentesis were also similar in both groups (1196.5 +/- 434.2-1217.0 +/- 405.7 pg mL(-1); P = 0.7 in the albumin group and 1206.0 +/- 522.5-1273.5 +/- 444.8 pg mL(-1); P = 0.22 in the noradrenaline group). The cost of noradrenaline treatment was significantly lower when compared with that of albumin (P < 0.001).


CONCLUSIONS
Noradrenaline is as effective as albumin in preventing paracentesis-induced circulatory dysfunction in patients with cirrhosis after therapeutic paracentesis, but at a fraction of the cost.
Singh
V
V
Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. virendrasingh100@hotmail.com
Kumar
B
B
Nain
C K
CK
Singh
B
B
Sharma
N
N
Bhalla
A
A
Sharma
A K
AK
D000328:Adult; D000418:Albumins / Q000191:economics / Q000627:therapeutic use*; D000450:Aldosterone / Q000097:blood; D001810:Blood Volume / Q000187:drug effects; D016527:Drug Costs; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000191:economics / Q000627:therapeutic use*; D019152:Paracentesis / Q000009:adverse effects*; D010865:Pilot Projects; D012044:Regression Analysis; D012083:Renin / Q000097:blood; D014662:Vasoconstrictor Agents / Q000191:economics / Q000627:therapeutic use*
D000418:Albumins; D014662:Vasoconstrictor Agents; D000450:Aldosterone; D012083:Renin; D009638:Norepinephrine