title: Immune-Inflammatory and Metabolic Effects of High Dose Furosemide plus Hypertonic Saline Solution (HSS) Treatment in Cirrhotic Subjects with Refractory Ascites.
abstract: BACKGROUND
  Patients with chronic liver diseases are usually thin as a result of hypermetabolism and malnutrition expressed by reduced levels of leptin and impairment of other adyponectins such as visfatin.
  
  
  OBJECTIVE
  We evaluated the metabolic and inflammatory effects of intravenous high-dose furosemide plus hypertonic saline solutions (HSS) compared with repeated paracentesis and a standard oral diuretic schedule, in patients with cirrhosis and refractory ascites.
  
  
  METHODS
  59 consecutive cirrhotic patients with refractory ascites unresponsive to outpatient treatment. Enrolled subjects were randomized to treatment with intravenous infusion of furosemide (125-250mg⁄bid) plus small volumes of HSS from the first day after admission until 3 days before discharge (Group A, n:38), or repeated paracentesis from the first day after admission until 3 days before discharge (Group B, n: 21). Plasma levels of ANP, BNP, Leptin, visfatin, IL-1β, TNF-a, IL-6 were measured before and after the two type of treatment.
  
  
  RESULTS
  Subjects in group A were observed to have a significant reduction of serum levels of TNF-α, IL-1β, IL-6, ANP, BNP, and visfatin, thus regarding primary efficacy endpoints, in Group A vs. Group B we observed higher Δ-TNF-α, Δ-IL-1β, Δ-IL-6, Δ-ANP, Δ-BNP, Δ-visfatin, Δ-Leptin at discharge.
  
  
  CONCLUSIONS
  Our findings underline the possible inflammatory and metabolic effect of saline overload correction in treatment of cirrhosis complications such as refractory ascites, suggesting a possible role of inflammatory and metabolic-nutritional variables as severity markers in these patients.
authors.affiliation: U.O.C di Medicina Interna e con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Università degli Studi di Palermo (Italy).
authors.forename: Antonino
authors.initials: A
authors.lastname: Tuttolomondo
authors.affiliation: U.O.C di Medicina Interna e con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Università degli Studi di Palermo (Italy).
authors.forename: Domenico
authors.initials: D
authors.lastname: Di Raimondo
authors.affiliation: Sezione di Biochimica Clinica e Medicina Molecolare Clinica, Dipartimento di Biopatologia e Biotecnologie Mediche e Forensi, Università degli Studi di Palermo U.O.C. CoreLab, Azienda Ospedaliera Universitaria Policlinico, Palermo, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Bellia
authors.affiliation: U.O.C di Medicina Interna e con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Università degli Studi di Palermo (Italy).
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Clemente
authors.affiliation: U.O.C di Medicina Interna e con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Università degli Studi di Palermo (Italy).
authors.forename: Rosaria
authors.initials: R
authors.lastname: Pecoraro
authors.affiliation: U.O.C di Medicina Interna e con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Università degli Studi di Palermo (Italy).
authors.forename: Carlo
authors.initials: C
authors.lastname: Maida
authors.affiliation: U.O.C di Medicina Interna e con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Università degli Studi di Palermo (Italy).
authors.forename: Irene
authors.initials: I
authors.lastname: Simonetta
authors.affiliation: U.O.C di Medicina Interna e con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Università degli Studi di Palermo (Italy).
authors.forename: Valerio
authors.initials: V
authors.lastname: Vassallo
authors.affiliation: School and Chair of Allergology, Dipartimento delle Emergenze e Trapianti d'Organo, University of Bari, Italy.
authors.forename: Danilo
authors.initials: D
authors.lastname: Di Bona
authors.affiliation: Dipartimento di Chirurgia Generale e d'Urgenza, Policlinico Universitario "Paolo Giaccone, University of Palermo, Italy.
authors.forename: Eliana
authors.initials: E
authors.lastname: Gulotta
authors.affiliation: Sezione di Biochimica Clinica e Medicina Molecolare Clinica, Dipartimento di Biopatologia e Biotecnologie Mediche e Forensi, Università degli Studi di Palermo U.O.C. CoreLab, Azienda Ospedaliera Universitaria Policlinico, Palermo, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Ciaccio
authors.affiliation: U.O.C di Medicina Interna e con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Università degli Studi di Palermo (Italy).
authors.forename: Antonio
authors.initials: A
authors.lastname: Pinto
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D001201:Ascites / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D015415:Biomarkers; D016207:Cytokines / Q000378:metabolism; D004232:Diuretics / Q000008:administration & dosage*; D005260:Female; D005665:Furosemide / Q000008:administration & dosage*; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D016207:Cytokines; D004232:Diuretics; D018836:Inflammation Mediators; D012462:Saline Solution, Hypertonic; D005665:Furosemide