Oral midodrine is comparable to albumin infusion in cirrhotic patients with refractory ascites undergoing large-volume paracentesis: results of a pilot study

Yosry, Ayman; Abdellatif, Zeinab; Eletreby, Rasha; Hamza, Iman; Ismail, Alaa; Elkady, Mohammad A.

doi:10.1097/meg.0000000000001277

Cited by 15 publications

(15 citation statements)

References 22 publications

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“…One trial was multiarmed comparing albumin against Dextran 70 and polygeline 2 . Studies with no active comparator (or placebo) were excluded 23 . Three studies were excluded as they had not defined the primary outcome based on PRA 23‐25 .…”

Section: Resultsmentioning

confidence: 99%

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Prevention of paracentesis‐induced circulatory dysfunction—A systematic review and network meta‐analysis

et al. 2020

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Background: Paracentesis-induced circulatory dysfunction (PICD) is seen in up to 70% of patients undergoing large volume paracentesis (LVP). We performed comparative effectiveness of available pharmacological interventions for the prevention of PICD in cirrhotic patients undergoing LVP. Methods: A comprehensive search of electronic databases from inception to March 2019 was carried out. Adult patients aged > 18 years diagnosed as cirrhosis of liver undergoing LVP comparing active pharmacological interventions with each other or placebo for prevention of PICD (defined by a rise in plasma renin activity by ≥ 50% of baseline or by ≥ 4 ng/ml/h on the fifth or sixth day after LVP) were included. Direct and Bayesian network meta-analysis (NMA) was performed to assess all the available pharmacological interventions. We followed GRADE (Grading of Recommendations Assessment, Development and Evaluation system) criteria for appraising confidence in estimates. Results: Nine RCTs including 620 cirrhotic patients undergoing LVP were included for final meta-analysis after screening 448 studies. Seven interventions were compared with a common comparator (albumin 8g/L) for the prevention of PICD (n = 605 patients). In a direct meta-analysis, albumin (8g/L) was superior only to other volume expanders but not to vasoconstrictors. However, in NMA, low-quality evidence (Grade-⊕⊕) supported midodrine given for 3 days as superior to albumin (8g/L) in the prevention of PICD (surface under the cumulative ranking curve (SUCRA): midodrine 3 days-95.05%; albumin 8g/L −73.21%). The cost of albumin therapy was 306.9$, and midodrine was 29.4$. Conclusion: Midodrine for 3 days is economical and superior to albumin in the prevention of PICD in cirrhosis patients undergoing LVP. | 93 KULKARNI et AL. S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Kulkarni AV, Kumar P, Singh S, et al. Prevention of paracentesis-induced circulatory dysfunction-A systematic review and network meta-analysis. GastroHep.

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Section: Resultsmentioning

confidence: 99%

“…Studies with no active comparator (or placebo) were excluded 23 . Three studies were excluded as they had not defined the primary outcome based on PRA 23‐25 . One study was excluded as they have not given the absolute value of PRA 26 .…”

Section: Resultsmentioning

confidence: 99%

Prevention of paracentesis‐induced circulatory dysfunction—A systematic review and network meta‐analysis

et al. 2020

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“…A combination of albumin with octreotide at a dose of 200 microgram subcutaneously three times a day and oral at a titrated dose of upto 12.5mg three times a day has been of benefit in a few studies from the US and Europe. 48,123 This combination was found to be superior to dopamine combined with albumin. 124 Noradrenaline at a dose of 0.5-3mg/h is infused continuously dose is gradually increased to achieve a raise in arterial blood pressure and improvement in renal parameters in HRS-AKI.…”

Section: Vasoconstrictor Agents and Albuminmentioning

confidence: 94%

“…Long-duration midodrine intake can be more useful than shorter duration intake in terms of improvement of renal perfusion and sodium excretion. [48][49][50][51] Beta blockers have been proven to have a deleterious effect on survival in patients with refractory ascites and should be stopped. 52,53 Recommendations:…”

Section: Diuretic-induced Complicationsmentioning

confidence: 99%

HEP-Net opinion on the management of ascites and its complications in the setting of decompensated cirrhosis in the resource constrained environment of Pakistan

et al. 2020

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Approximately one half of patients develop ascites within 10 years of diagnosis of compensated cirrhosis. It is a poor prognostic indicator, with only 50% surviving beyond two years. Mortality worsens significantly to 20% to 50% at one year if the ascites becomes refractory to medical therapy. Pakistan has one of the highest prevalence of viral hepatitis in the world and patients with ascites secondary to liver cirrhosis make a major percentage of both inpatient and outpatient burden. Studies indicate that over 80% of patients admitted with ascites have liver cirrhosis as the cause. This expert opinion suggests proper assessment of patients with ascites in the presence of underlying cirrhosis. This expert opinion includes appropriate diagnosis and management of uncomplicated ascites, refractory ascites and complicated ascites (including spontaneous bacterial peritonitis (SBP) ascites, hepatorenal syndrome (HRS) and hyponatremia. The purpose behind this expert opinion is to help consultants, postgraduate trainees, medical officers and primary care physicians optimally manage their patients with cirrhosis and ascites in a resource constrained setting as is often encountered in a developing country like Pakistan. doi: https://doi.org/10.12669/pjms.36.5.2407 How to cite this:Ali B, Salim A, Alam A, Zuberi BF, Ali Z, Azam Z, et al. HEP-Net opinion on the management of ascites and its complications in the setting of decompensated cirrhosis in the resource constrained environment of Pakistan. Pak J Med Sci. 2020;36(5):---------. doi: https://doi.org/10.12669/pjms.36.5.2407 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…Included studies are reference nos. [1,3,4,[6][7][8][14][15][16][17][18][19][20][21][22] Data Analysis…”

Section: Figure 1: Risk Of Bias Assessment Of Included Rctsmentioning

confidence: 99%

Midodrine in Liver Cirrhosis With Ascites: A Systematic Review and Meta-Analysis

Shrestha¹,

Budhathoki²,

Sedhai³

et al. 2022

Cureus

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Ascites is the most common complication of liver cirrhosis. Midodrine is a vasoconstrictor that improves splanchnic and systemic hemodynamics, reduces ascites, and improves clinical outcomes. Here, we aimed to examine the role of midodrine in cirrhosis-related ascites.Scopus, Embase, PubMed, and PubMed Central databases were searched for relevant randomized controlled trials comparing midodrine with other interventions in patients with cirrhotic ascites on November 25, 2020, using appropriate keywords like "midodrine", "ascitic cirrhosis", "peritoneal paracentesis" and suitable Boolean operators. Odds ratio (OR) and mean difference (MD) were used to analyze pool data as appropriate with a 95% confident interval (CI).A total of 14 studies were included in our analysis including 1199 patients. The addition of midodrine resulted in statistically significant improvement in mean arterial pressure (MAP) (MD, 3.95 mmHg; 95% CI, 1.53-6.36) and MELD (Model for End-Stage Liver Disease) score (MD, -1.27; 95% CI, -2.49 to -0.04) compared to standard medical treatment (SMT). There was also a significant improvement in plasma renin activity and plasma aldosterone concentration. However, there was no significant improvement in mortality or serum creatinine compared to SMT. In addition, there was no statistically significant improvement in MAP, plasma renin activity, plasma aldosterone concentration, MELD score, overall mortality, and paracentesis-induced circulatory dysfunction comparing midodrine with albumin.Midodrine alone leads to significant improvement in various clinical parameters in patients with cirrhotic ascites compared to standard medical care. At the same time, it was found to be non-inferior to albumin. Therefore, further well-designed studies need to be carried out on midodrine in addition to albumin for optimal clinical benefits among patients with ascites due to cirrhosis.

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Oral midodrine is comparable to albumin infusion in cirrhotic patients with refractory ascites undergoing large-volume paracentesis: results of a pilot study

Cited by 15 publications

References 22 publications

Prevention of paracentesis‐induced circulatory dysfunction—A systematic review and network meta‐analysis

Prevention of paracentesis‐induced circulatory dysfunction—A systematic review and network meta‐analysis

HEP-Net opinion on the management of ascites and its complications in the setting of decompensated cirrhosis in the resource constrained environment of Pakistan

Midodrine in Liver Cirrhosis With Ascites: A Systematic Review and Meta-Analysis

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