Plasma expanders for people with cirrhosis and large ascites treated with abdominal paracentesis

Simonetti, Rosa G; Nikolova, Dimitrinka; Bjelaković, Goran; Gluud, Christian

doi:10.1002/14651858.cd004039.pub2

Cited by 20 publications

(25 citation statements)

References 139 publications

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“…A recent Cochrane review, 34 which included 27 randomised trials, concluded that there was neither any benefit nor any adverse effect in using any plasma expanders, including albumin, polygeline, dextran, hydroxyethyl starch, intravenous infusion of ascitic fluid or crystalloids in patients undergoing paracentesis. The authors further argued that the data on albumin/volume expanders originated from few, small, short‐term trials that are at high risks of systemic errors, selection bias and random errors.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…In the only trial comparing albumin to no treatment, there was no difference in mortality ( p = 0.37). There is a systematic review published in 2019 by the Cochrane Hepato‐Biliary Group that was not available for citation during the compilation of current clinical practice guidelines 36 . Based on very low certainty due to the high risk of bias and random errors associated with the small, short‐term trials, the authors could not determine benefit or harm of plasma expansion versus no plasma expansion, or of any differences between plasma expanders.…”

Section: Commentmentioning

confidence: 99%

Albumin for cirrhosis‐related complications

Erstad

2021

J Clin Pharm Ther

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What is known and objective The purpose of this paper was to discuss the limitations of the studies serving as the evidence for recommendations in clinical practice guidelines concerning albumin use for cirrhosis‐related complications, review relevant studies published since the guidelines and suggest directions for future investigations. Comment There are no recent comprehensive clinical practice guidelines concerning albumin. Instead, more recent albumin guidelines reflect areas of specialty practice such as those by American and European associations for the study of the liver and liver disease. Studies published since the guidelines are useful for helping to define the most appropriate indications for albumin with respect to cirrhosis‐related complications, as well as directions for future research. What is new and conclusion Albumin has a long history of attempts to define appropriate uses by meta‐analysis, but given the high cost and episodic shortages of albumin, there is a need for adequately powered randomized controlled trials using current state‐of‐the‐art care evaluating the use of albumin to prevent or treat cirrhosis‐related complications.

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“…A recent Cochrane review, 52 which included 27 randomized trials, concluded that there was neither any benefit nor any adverse effect in using any plasma expander, including albumin, polygeline, dextrans, hydroxyethyl starch, intravenous infusion of ascitic fluid, and crystalloids in patients undergoing paracentesis. The data on albumin/volume expanders originated from a few, small, short-term trials that were at high risk of systemic errors, selection bias, and random errors.…”

Section: Meta-analysismentioning

confidence: 99%

Pathophysiology and Prevention of Paracentesis-induced Circulatory Dysfunction: A Concise Review

Kulkarni¹,

Kumar²,

Sharma³

et al. 2020

Journal of Clinical and Translational Hepatology

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Annually, 10% of cirrhotic patients with ascites develop refractory ascites for which large-volume paracentesis (LVP) is a frequently used therapeutic procedure. LVP, although a safe method, is associated with circulatory dysfunction in a significant percentage of patients, which is termed paracentesis-induced circulatory dysfunction (PICD). PICD results in faster reaccumulation of ascites, hyponatremia, renal impairment, and shorter survival. PICD is diagnosed through laboratory results, with increases of >50% of baseline plasma renin activity to a value $4 ng/mL/h on the fifth to sixth day after paracentesis. In this review, we discuss the pathophysiology and prevention of PICD.

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Plasma expanders for people with cirrhosis and large ascites treated with abdominal paracentesis

Abstract: Analysis 2.3. Comparison 2 Subgroup analysis of plasma expanders versus no plasma expander regarding modality of paracentesis, Outcome

Cited by 20 publications

References 139 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

Albumin for cirrhosis‐related complications

Pathophysiology and Prevention of Paracentesis-induced Circulatory Dysfunction: A Concise Review

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