title: Preservation of nutritional-status in patients with refractory ascites due to hepatic cirrhosis who are undergoing repeated paracentesis.
abstract: OBJECTIVE
  Refractory ascites in liver-cirrhosis is associated with a poor prognosis. We performed a prospective study to investigate whether aggressive nutritional-support could improve outcomes in cirrhotic patients.
  
  
  METHODS
  Cirrhotic patients undergoing serial large-volume paracentesis for refractory-ascites were enrolled and randomized into three groups. Group A received post-paracentesis intravenous nutritional-support in addition to a balanced oral diet and a late-evening protein snack, group B received the same oral nutritional-protocol as the first group but without parenteral support, and group C (the control group) received a low-sodium or sodium-free diet. Clinical, anthropometric and laboratory nutritional parameters and biochemical tests of liver and renal function were reported for 12 months of follow-up.
  
  
  RESULTS
  We enrolled 120 patients, who were randomized into three groups of equal size. Patients on the nutritional-protocol showed better preservation of clinical, anthropometric and laboratory nutritional parameters that were associated with decreased deterioration of liver function compared with patients on the low-sodium or sodium-free diet (group C). Groups A and B had lower morbidity and mortality rates than the control group (C). Mortality rates were significantly better in patients who were treated with parenteral-nutritional-support than for the other two groups. In patients who were on the nutritional-protocol, there was a reduction in the requirement of taps for the treatment of refractory ascites.
  
  
  CONCLUSIONS
  Post-paracentesis parenteral-nutritional-support with a balanced oral diet and an evening protein snack appears to be the best care protocol for patients with liver-cirrhosis that has been complicated by refractory-ascites.
authors.affiliation: Liver Unit, Clinical and Experimental Hepatology, Department of Internal Medicine, S.G. Moscati Hospital, Avellino, Italy. paolosorrmed@tin.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Sorrentino
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Castaldo
authors.forename: Luciano
authors.initials: L
authors.lastname: Tarantino
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bracigliano
authors.forename: Alessandro
authors.initials: A
authors.lastname: Perrella
authors.forename: Oreste
authors.initials: O
authors.lastname: Perrella
authors.forename: Francesco
authors.initials: F
authors.lastname: Fiorentino
authors.forename: Raffaela
authors.initials: R
authors.lastname: Vecchione
authors.forename: Salvatore
authors.initials: S
authors.lastname: D' Angelo
mesh_terms: D000368:Aged; D000597:Amino Acids, Branched-Chain / Q000008:administration & dosage; D001201:Ascites / Q000209:etiology / Q000628:therapy; D004039:Diet, Sodium-Restricted; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006501:Hepatic Encephalopathy / Q000209:etiology; D006530:Hepatorenal Syndrome / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications* / Q000178:diet therapy / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D019152:Paracentesis / Q000009:adverse effects; D010288:Parenteral Nutrition; D010538:Peritonitis / Q000382:microbiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018709:Statistics, Nonparametric
chemical_list: D000597:Amino Acids, Branched-Chain; D004044:Dietary Proteins