Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis

Ginés, Àngels; Fernández‐Esparrach, Glòria; Monescillo, Alberto; Martinez-Vila, Clara; Domingo‐Domenech, Eva; Abecasis, Raquel; Angeli, Paolo; Ruíz-del-Árbol, Luís; Planas, Ramón; Solá, Ricard; Ginès, Pere; Terg, Rubén; Inglada, Luís; Vaque, P; Salerno, Francesco; Vargas, Vı́ctor; Clemente, G.; Quer, JC; Jiménez, W.; Arroyo, Vicente; Rodés, Juan

doi:10.1016/s0016-5085(96)70068-9

Cited by 506 publications

(399 citation statements)

References 7 publications

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“…However, Gines et al showed that PPH, as defined by an increase in plasma renin activity or aldosterone concentrations, was prevented more effectively by albumin than synthetic plasma expanders. 35 Contraindications and Complications of Paracentesis. Depite the fact that all published studies on paracentesis have excluded patients with SBP, renal failure, severe hepatic encephalopathy, thrombocytopenia, low blood pressure, or severe jaundice, there is no evidence that these complications should be considered as contraindications for paracentesis in clinical practice.…”

Section: Paracentesismentioning

confidence: 99%

The management of ascites in cirrhosis: Report on the consensus conference of the International Ascites Club

et al. 2003

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Ascites is a common complication of cirrhosis, and heralds a new phase of hepatic decompensation in the progression of the cirrhotic process. The development of ascites carries a significant worsening of the prognosis. It is important to diagnose noncirrhotic causes of ascites such as malignancy, tuberculosis, and pancreatic ascites since these occur with increased frequency in patients with liver disease. The International Ascites Club, representing the spectrum of clinical practice from North America to Europe, have developed guidelines by consensus in the management of cirrhotic ascites from the early ascitic stage to the stage of refractory ascites. Mild to moderate ascites should be managed by modest salt restriction and diuretic therapy with spironolactone or an equivalent in the first instance. Diuretics should be added in a stepwise fashion while maintaining sodium restriction. Gross ascites should be treated with therapeutic paracentesis followed by colloid volume expansion, and diuretic therapy. Refractory ascites is managed by repeated large volume paracentesis or insertion of a transjugular intrahepatic portosystemic stent shunt (TIPS). Successful placement of TIPS results in improved renal function, sodium excretion, and general well-being of the patient but without proven survival benefits. Clinicians caring for these patients should be aware of the potential complications of each treatment modality and be prepared to discontinue diuretics or not proceed with TIPS placement should complications or contraindications develop. Liver transplantation should be considered for all ascitic patients, and this should preferably be performed prior to the development of renal dysfunction to prevent further compromise of their prognosis. (HEPATOLOGY 2003;38:258-266.)

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Section: Paracentesismentioning

confidence: 99%

The management of ascites in cirrhosis: Report on the consensus conference of the International Ascites Club

et al. 2003

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“…Large volume paracentesis and albumin infusion is the treatment of choice for patients with ascites resistant to diuretic treatment [32,33]. Paracentesis is an invasive, though safe procedure, with an extremely low risk of local complications such as hemorrhage or bowel perforation.…”

Section: Ascites and Spontaneous Bacterial Peritonitismentioning

confidence: 99%

Clinical implications of the hyperdynamic syndrome in cirrhosis

Licata

Mazzola

Ingrassia

et al. 2014

European Journal of Internal Medicine

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The hyperdynamic syndrome is a late consequence of portal hypertension in cirrhosis. The principal hemodynamic manifestations of the hyperdynamic syndrome are high cardiac output, and increased heart rate and total blood volume, accompanied by reduced total systemic vascular resistance. Pathophysiology involves a complex of humoral and neural mechanisms that can determine hemodynamic changes, and lead to hyperdynamic circulation. In this review we focus our attention on the manifestations of the hyperdynamic syndrome. Some of these are well described and directly related to portal hypertension (varices, ascites, hepatic encephalopathy, and hepatorenal syndrome), while others, such as hepatopulmonary syndrome, portopulmonary hypertension, and cirrhotic cardiomyopathy, are less known as clinical manifestations related to cirrhosis and, therefore, merit further investigation.

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“…47 Although another study has documented that the subset of patients who develop a post-paracentesis rise in plasma renin have decreased life expectancy, there has been no study large enough to show decreased survival in patients who did not receive any plasma expander compared with patients administered albumin after paracentesis. 48 Despite the lack of a proven survival advantage, albumin is being used after therapeutic paracentesis. However, albumin infusions markedly increase albumin degradation, and albumin is very expensive.…”

Section: Introductionmentioning

confidence: 99%

Management of adult patients with ascites caused by cirrhosis

Runyon¹

1998

Hepatology

302

131

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Ascites is the most common of the major complications of cirrhosis. The development of ascites is an important landmark in the natural history of cirrhosis and has been proposed as an indication for liver transplantation. The initial evaluation of a patient with ascites should include a history, physical evaluation, and abdominal paracentesis with ascitic fluid analysis. Treatment should consist of abstinence from alcohol, sodium restricted diet, and diuretics. This regimen is effective in Ϸ90% of patients. The treatment options for the diuretic-resistant patients include serial therapeutic paracenteses, liver transplantation, and peritoneovenous shunting. (HEPATOLOGY 1998;27;264-272.) PREAMBLE These guidelines provide a data-supported approach to the care of patients with ascites. They are based on the following: 1) a formal review and analysis of the published world literature (1,045 papers) on ascites (Medline Search from 1966-1996, search terms included ascites, diet therapy, drug therapy, radiotherapy, surgery, and therapy); 2) the American College of Physician' s Manual for Assessing Health Practices and Designing Practice Guidelines 1 ; and 3) several published and draft guidelines, including the American Association for the Study of Liver Diseases' Policy Statement on Development and Use of Practice Guidelines and American Gastroenterological Association' s Policy Statement on Guidelines 2 ; and 4) 15 years of experience on the part of the author in the clinical and laboratory investigations of and care for patients with this problem.These guidelines, intended for use by physicians, suggest preferable approaches to the diagnostic, therapeutic, and preventative aspects of care. These guidelines are intended to be flexible, in contrast with ''standards of care,'' which are inflexible policies to be followed in almost every case. 1 Furthermore, these guidelines were developed for the care of adult patients with clinically detectable ascites. Although the general approach may be applicable to children, the pediatric data base is much smaller and there may be unanticipated differences between adults and children. Patients with ascites that is detected by imaging modalities alone, but not yet clinically evident, are not included because of the lack of published information regarding the natural history of this entity.Specific recommendations are based on relevant published information. In an attempt to standardize recommendations, the Practice Guidelines Committee of the American Association for the Study of Liver Diseases modified the categories of the Infectious Diseases Society of America' s Quality Standards. 3 These categories are reported with each recommendation, using the letters A through E to determine the strength of recommendation and roman numerals I through III to determine quality of evidence upon which recommendations are based, as follows: A, survival benefit; B, improved diagnosis; C, improvement in quality of life; D, relevant pathophysiologic parameters improved; E, impacts cost of heal...

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Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis

Cited by 506 publications

References 7 publications

The management of ascites in cirrhosis: Report on the consensus conference of the International Ascites Club

The management of ascites in cirrhosis: Report on the consensus conference of the International Ascites Club

Clinical implications of the hyperdynamic syndrome in cirrhosis

Management of adult patients with ascites caused by cirrhosis

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