title: Safety of paracentesis in inpatients.
abstract: 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.
authors.affiliation: Division of Gastroenterology, West Penn Allegheny Health System, Allegheny General Hospital, Pittsburgh, PA, USA.
authors.forename: P
authors.initials: P
authors.lastname: Duggal
authors.forename: K F
authors.initials: KF
authors.lastname: Farah
authors.forename: G
authors.initials: G
authors.lastname: Anghel
authors.forename: R J
authors.initials: RJ
authors.lastname: Marcus
authors.forename: A R
authors.initials: AR
authors.lastname: Lupetin
authors.forename: M M
authors.initials: MM
authors.lastname: Babich
authors.forename: S E
authors.initials: SE
authors.lastname: Sandroni
authors.forename: R L
authors.initials: RL
authors.lastname: McGill
mesh_terms: 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*
chemical_list: D000418:Albumins; D003404:Creatinine