Paracentesis-Induced Circulatory Dysfunction With Modest-Volume Paracentesis Is Partly Ameliorated by Albumin Infusion in Acute-on-Chronic Liver Failure.

Abstract

Paracentesis-induced circulatory dysfunction (PICD) is a serious complication of large-volume (>5L) paracentesis in cirrhosis and is reduced with albumin infusion. There is a lack of data on PICD in acute-on-chronic liver failure (ACLF). Because ACLF patients have greater hemodynamic derangements than patients with decompensated cirrhosis, we investigated whether PICD could develop with modest-volume paracentesis (MVP) and the role of albumin infusion. A total of 80 ACLF patients undergoing <5L paracentesis were randomized to receive albumin (8 g/dL of ascitic fluid; n=40) or no albumin (n=40) and serially followed to detect PICD. Baseline characteristics were comparable between groups, including volume of ascitic tap (4.16±0.23 versus 4.14±0.27 L; P=0.72) and plasma renin activity (PRA; 20.5±7.03 versus 23.2±8.24ng/mL/hour; P=0.12). PICD was more frequent in the no-albumin group than the albumin group (70% versus 30%; P=0.001), with higher incidence of hepatic encephalopathy (50% versus 27.5%; P=0.04), hyponatremia (67.5% versus 22.5%; P<0.001), acute kidney injury (62.5% versus 30%; P=0.001), and in-house mortality (62.5% versus 27.5%; P=0.003). PRA of 25.15ng/mL at day 3 had sensitivity and specificity of 71% and 68%, respectively, for development of PICD at day 6. Albumin infusion decreased the incidence of PICD at day 6 (odds ratio, 0.068; 95% confidence interval, 0.011-0.43; P=0.005). PICD is common and develops even with MVP in ACLF patients. Albumin infusion decreases the incidence of PICD and mortality in patients with ACLF. Clinical trial identifier: NCT02467348.