Abstract
Cell-free and concentrated ascites reinfusion therapy (CART) is frequently used to treat refractory ascites in Japan. However, its efficacy remains unclear. This controlled cohort study verified the serum albumin elevating effect of CART by comparisons with simple paracentesis. Ascites patients receiving CART (N = 88) or paracentesis (N = 108) at our hospital were assessed for the primary outcome of change in serum albumin level within 3 days before and after treatment. A significantly larger volume of ascites was drained in the CART group. The change in serum albumin level was +0.08 ± 0.25 g/dL in the CART group and −0.10 ± 0.30 g/dL in the paracentesis group (P < 0.001). The CART – paracentesis difference was +0.26 g/dL (95%CI +0.18 to +0.33, P < 0.001) after adjusting for potential confounders by multivariate analysis. The adjusted difference increased with drainage volume. In the CART group, serum total protein, dietary intake, and urine volume were significantly increased, while hemoglobin and body weight was significantly decreased, versus paracentesis. More frequent adverse events, particularly fever, were recorded for CART, although the period until re-drainage was significantly longer. This study is the first demonstrating that CART can significantly increase serum albumin level as compared with simple paracentesis. CART represents a useful strategy to manage patients requiring ascites drainage.
Highlights
Refractory ascites patients often develop hypoalbuminemia due reasons such as protein leakage into ascites[1] and body protein consumption by underlying diseases[2,3]
Age, sex, physique, body temperature, urine volume, and dietary intake did not differ remarkably between the concentrated ascites reinfusion therapy (CART) group and paracentesis group, mean blood pressure was significantly higher for paracentesis (P = 0.032) (Table 1)
We investigated the efficacy of CART in this controlled cohort study by comparisons with simple paracentesis to clearly demonstrate a serum albumin elevating effect
Summary
Refractory ascites patients often develop hypoalbuminemia due reasons such as protein leakage into ascites[1] and body protein consumption by underlying diseases[2,3]. To prevent hypoalbuminemia by the loss of ascites protein[19], cell-free and concentrated ascites reinfusion therapy (CART) was developed in Japan in the 1970s20. CART is frequently performed in Japan[22] and has undergone several improvements, such as establishing the safety of draining large amounts of ascites[23,24,25,26,27,28], indication expansion to cancerous ascites[29,30], and the development of external pressure type filtration methods whose filter membrane can be washed[24,25]. Even controlled comparisons with simple paracentesis, which is the most common non-drug treatment for ascites[17,18], have not been conducted[32]. We conducted a retrospective cohort study using medical records at our hospital to compare the changes in serum albumin level before and after treatment between CART and paracentesis
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