title: Post-paracentesis circulatory derangements are related to monocyte activation.
abstract: OBJECTIVE
  Post-paracentesis circulatory dysfunction is associated with development of hepatorenal syndrome and increased mortality. The impact of large volume paracentesis (LVP) on the 24-h blood pressure (BP) profile is unknown, and the relationship to Na+-retentive and pro-inflammatory cytokines also remains unknown. The aims of this study were to (i) define the effects of LVP with albumin administration on 24-h BP profiles, and (ii) relate changes in BP over time to changes in Na+-retentive hormones, clinical factors and inflammatory cytokines.
  
  
  METHODS
  Ten patients undergoing LVP had 24-h ambulatory BP monitoring performed pre- and post-paracentesis. Markers of the innate immune system, bacterial translocation and Na+-retentive hormones were drawn pre- and post-LVP.
  
  
  RESULTS
  Mean arterial pressure (MAP) dropped in nine of the 10 patients in the 24 h following a paracentesis compared to 24 h preceding the procedure (mean drop of 5.5 mmHg, P<0.005). A mixed effects model was used to define time-covariate interactions in predicting changes in BP profile. Monocyte chemotactic protein-1 (MCP1) was associated with Δsystolic BP (β=-0.011, P<0.05), Δdiastolic BP (β=-0.012, P<0.05) and ΔMAP (β=-0.012, P<0.05). Plasma renin activity was also significantly associated with Δsystolic BP (β=-0.21, P<0.05). Renal function was also significantly reduced following LVP.
  
  
  CONCLUSIONS
  Systolic, diastolic and MAP decreased over 24 h after LVP compared to the 24 h pre-LVP. This drop is related to increases in MCP-1 after LVP. Increased MCP-1, a marker of monocyte activation, was strongly related to changes in BP.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University (VCU), Richmond, VA, USA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Carl
authors.forename: Siddharta
authors.initials: S
authors.lastname: Ghosh
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Cheng
authors.forename: Todd W B
authors.initials: TW
authors.lastname: Gehr
authors.forename: R Todd
authors.initials: RT
authors.lastname: Stravitz
authors.forename: Arun
authors.initials: A
authors.lastname: Sanyal
mesh_terms: D001201:Ascites / Q000209:etiology / Q000601:surgery*; D001794:Blood Pressure / Q000502:physiology; D016207:Cytokines / Q000097:blood; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000502:physiology; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000502:physiology*; D019152:Paracentesis / Q000009:adverse effects*; D011446:Prospective Studies; D012083:Renin / Q000097:blood; D012709:Serum Albumin / Q000494:pharmacology; D012769:Shock / Q000209:etiology* / Q000503:physiopathology* / Q000517:prevention & control; D014664:Vasodilation / Q000502:physiology; D014768:Virginia
chemical_list: D016207:Cytokines; D012709:Serum Albumin; D012083:Renin
keywords: 24-h ambulatory blood pressure monitoring; cirrhosis; inflammation; paracentesis