Abstract
IntroductionPatients 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.AimsWe 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.Methods59 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.ResultsSubjects 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.DiscussionOur 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.
Highlights
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
The hypothesis of our study was that the clinical effectiveness of high dose furosemide + hypertonic saline solutions (HSS) could be accomplished by parallel effects on inflammatory, natriuretic and metabolic pathways expressed by changes of cytokines, natriuretic peptides, leptin and visfatin serum levels after treatment
On the basis of our previous own results from another clinical trial [10], we evaluated the metabolic and inflammatory effects of intravenous high-dose furosemide plus HSS compared with repeated paracentesis and a standard oral diuretic schedule, in patients with cirrhosis and refractory ascites, evaluating their effects on a panel of serum biomarkers such as some inflammatory cytokines, ANP/B-type natriuretic peptide (BNP), leptin and visfatin serum levels by means of analysis of differences of their serum levels before and after treatment with high dose furosemide + HSS
Summary
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. Data Availability Statement: All relevant data are within the paper, supporting information files, and the public repository Figshare. Figshare data can be found at the following DOI and URL: DOI: 10.6084/ m9.figshare.4141707.
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