title: The impact of paracentesis flow rate in patients with liver cirrhosis on the development of paracentesis induced circulatory dysfunction.
abstract: OBJECTIVE
  Ascites is a dreadful complication of liver cirrhosis associated with short survival. Large volume paracentesis (LVP) is used to treat tense or refractory ascites. Paracentesis induced circulatory dysfunction (PICD) develops if no plasma expanders are given with ominous complications. To study the effect of ascites flow rate on PICD development.
  
  
  METHODS
  Sixty patients with cirrhosis and tense ascites underwent LVP of 8 L were randomized into 3 equal groups of different flow rate extraction; group I (80 mL/minute), group II (180 mL/minute) and group III (270 mL/minute). Plasma renin activity (PRA) was measured baseline and on day six. PICD was defined as increase in PRA >50% of the pretreatment value.
  
  
  RESULTS
  In group I through 3; the mean age was (52.5±9.4 vs. 56.4±8.5 vs. 55.8±7.1 years; P>0.05), mean arterial pressure (81.4±5.6 vs. 81.5±7 vs. 79.5±7.2 mmHg; P>0.05), MELD (17.6±4.1 vs. 15.8±4.1 vs. 14.7±4.5). Baseline PRA was comparable (1,366.0±1244.9 vs. 1,151.3±1,444.8 vs. 951.9±1,088 pg/mL; P>0.05). There was no statistically significant (P>0.05) flow mediated changes (Δ) of creatinine (0.23±0.27 vs. 0.38±0.33 vs. 0.26±0.18 mg/dL), MELD (1.25±5.72 vs. 1.70±2.18 vs. 1.45±2.21) or PRA (450.93±614.10 vs. 394.61±954.64 vs. 629.51±1,116.46 pg/mL). PICD was detected in a similar frequency in the three groups (P>0.05). On univariate logistic analysis only female sex was a fairly significant PICD predictor (Wald 3.85, odds ratio 3.14; P=0.05).
  
  
  CONCLUSIONS
  The ascites flow rate does not correlate with PICD development.
authors.affiliation: Department of Hepatology, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt.
authors.forename: Maha Mohammad
authors.initials: MM
authors.lastname: Elsabaawy
authors.affiliation: Department of Hepatology, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt.
authors.forename: Shimaa Rashad
authors.initials: SR
authors.lastname: Abdelhamid
authors.affiliation: Department of Hepatology, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt.
authors.forename: Ayman
authors.initials: A
authors.lastname: Alsebaey
authors.affiliation: Department of Hepatology, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt.
authors.forename: Eman
authors.initials: E
authors.lastname: Abdelsamee
authors.affiliation: Department of Clinical Biochemistry, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt.
authors.forename: Manar Abdelaal
authors.initials: MA
authors.lastname: Obada
authors.affiliation: Department of Hepatology, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt.
authors.forename: Tary Abdelhamid
authors.initials: TA
authors.lastname: Salman
authors.affiliation: Department of Hepatology, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt.
authors.forename: Eman
authors.initials: E
authors.lastname: Rewisha
mesh_terms: D000328:Adult; D000368:Aged; D001158:Arteries / Q000502:physiology; D001794:Blood Pressure; D003404:Creatinine / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000473:pathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000009:adverse effects*; D012083:Renin / Q000097:blood; D012737:Sex Factors; D012769:Shock / Q000175:diagnosis / Q000209:etiology*
chemical_list: D003404:Creatinine; D012083:Renin
keywords: Ascites; Flow rate; Large volume paracentesis; Paracentesis induced circulatory dysfunction