Safety of paracentesis in inpatients.
BACKGROUND
Prior research has suggested that paracentesis is free from complications such as acute renal failure (ARF) providing albumin is administered. Actual safety of paracentesis > 1,000 ml was assessed at a tertiary care hospital.


METHODS
300 inpatient paracenteses performed between 12/99 and 4/04 were identified by coding records, of which 40 procedures were excluded due to lack of pre- or post-procedure lab values. Charts were reviewed for serum creatinine (Scr) before and after procedures, ascites volume, and clinical outcomes.


RESULTS
44 deaths occurred after 260 paracenteses (16.9%). Among 33 patients with ARF, 13 (39.4%) died. Only 31/227 patients without ARF (13.7%) died (p < 0.001). Serum creatinine (Scr) > 1.6 mg/dl prior to paracentesis predicted a 22.5% rate of ARF, compared to 8% for Scr < 1.0 (p = 0.002). ARF increased as volume increased (9.9%, 12.4%, and 14.9%, for volumes of < 2,300, 2,300 - 3,200, and > 3,200 ml) but this trend did not have statistical significance (p = 0.426). ARF occurred in 11/69 (15.9%) of patients receiving albumin, compared to 22/191 (11.5%) of patients who did not (p = 0.462).


CONCLUSIONS
Paracentesis in inpatients has significant rates of ARF and death. Scr > 1.6 prior to paracentesis predicts an increased rate of ARF. Development of ARF is associated with an increased rate of death. No advantage was demonstrated with administration of albumin. Pre- and post-paracentesis labwork should be routine in inpatients.
Duggal
P
P
Division of Gastroenterology, West Penn Allegheny Health System, Allegheny General Hospital, Pittsburgh, PA, USA.
Farah
K F
KF
Anghel
G
G
Marcus
R J
RJ
Lupetin
A R
AR
Babich
M M
MM
Sandroni
S E
SE
McGill
R L
RL
D058186:Acute Kidney Injury / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000008:administration & dosage / Q000494:pharmacology; D003404:Creatinine / Q000097:blood; D003710:Demography; D004869:Equipment Safety; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000009:adverse effects / Q000295:instrumentation* / Q000592:standards*
D000418:Albumins; D003404:Creatinine