Safety, complications and outcome of large volume paracentesis with or without albumin therapy in children with severe ascites due to liver disease

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• 作者：Moinak Sen Sarma¹ ; Surender Kumar Yachha¹ ; ^{skyachha@yahoo.co.in" class="auth_mail" title="E-mail the corresponding author} ; Vijayalakshmi Bhatia² ; Anshu Srivastava¹ ; Ujjal Poddar¹
• 关键词：PPCD ; post-paracentesis circulatory dysfunction ; LVP ; large volume paracentesis ; AI ; albumin infused ; ANI ; albumin non-infused ; PRA ; plasma renin activity ; HRS ; hepatorenal syndrome ; RAAS ; renin-angiotensin activating system ; SVR ; systemic vascular resistance ; IAP ; intra-abdominal pressure ; SBP ; spontaneous bacterial peritonitis ; BCS ; Budd-Chiari syndrome ; DN ; diuretic naï ; ve ; DE ; diuretic exposed ; GFR ; glomerular filtration rate ; LFT ; liver function tests ; INR ; international normalized rati
• 刊名：Journal of Hepatology
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：63
• 期：5
• 页码：1126-1132
• 全文大小：710 K

文摘

There are currently no published data on post-paracentesis circulatory dysfunction (PPCD) or its prevention in children. Our study was aimed to analyze the safety and complications of large volume paracentesis (LVP) in children with severe ascites due to chronic liver disease with or without albumin therapy.

Methods

A prospective longitudinal observational study enrolled children with severe ascites who underwent single time LVP at admission. They were divided into albumin infused (AI) and albumin non-infused (ANI) groups. Hemodynamic monitoring and laboratory parameters including plasma renin activity (PRA) were compared between baseline, 48 h and day 6 of LVP. Their outcome at 3 months and maximal follow-up were noted.

Results

32 children (AI, n = 17; ANI, n = 15) had comparable baseline characteristics and 90.6% had high PRA at onset. The incidence of PPCD was 37.5% (ANI: 67%; AI: 12%, p = 0.003), occurred if ascitic fluid extraction was >197.5 ml/kg (sensitivity: 90%; specificity: 50%, p = 0.01) and if flow rate was higher in ANI group (1224 ± 476 vs. 678 ± 214 ml/h, p = 0.009). ANI patients were susceptible to asymptomatic, persistent hyponatremia (baseline vs. day 6, 131 ± 4 vs. 128 ± 6 mEq/L; p = 0.04) and had higher rates of recurrent ascites (42%) and hospital readmission (67%) within 3 months. No survival benefit among the AI or non-PPCD groups was demonstrated.

Conclusions

LVP is safe in all age groups, best performed under albumin cover to overcome the problems of PPCD and hyponatremia. It is prudent to restrict volume extraction to less than 200 ml/kg actual dry weight for all and flow rate of 680 ml/h in ANI.