Noradrenaline and albumin in paracentesis-induced circulatory dysfunction in cirrhosis: a randomized pilot study

J Intern Med. 2006 Jul;260(1):62-8. doi: 10.1111/j.1365-2796.2006.01654.x.

Abstract

Objective: Therapeutic paracentesis in patients with cirrhosis is associated with a circulatory dysfunction. Intravenous albumin has been used to prevent the circulatory dysfunction; however, the use of albumin is controversial and costly. Splanchnic vasodilation is mainly responsible for circulatory dysfunction in these patients. There are no reports of use of noradrenaline, a vasoconstrictor, on the prevention of paracentesis-induced circulatory dysfunction in patients with cirrhosis. Therefore, we studied the preventive effect of noradrenaline on paracentesis-induced circulatory dysfunction in patients with cirrhosis after therapeutic paracentesis and compared it with that of intravenous albumin in a randomized pilot study.

Methods: Forty patients with cirrhosis and tense ascites underwent therapeutic paracentesis with albumin or noradrenaline in a randomized controlled trial at a tertiary centre. Effective arterial blood volume was assessed by measuring plasma renin activity at baseline and at 6 days after treatment.

Results: Effective arterial blood volume as indicated by plasma renin activity before and 6 days after paracentesis did not differ in the two groups (20.62 +/- 10.27-22.02 +/- 10.15 ng mL(-1) h(-1); P = 0.11 in the albumin group and 19.66 +/- 8.91-20.78 +/- 9.41 ng mL(-1) h(-1); P = 0.37 in the noradrenaline group). Plasma aldosterone concentration before and 6 days after paracentesis were also similar in both groups (1196.5 +/- 434.2-1217.0 +/- 405.7 pg mL(-1); P = 0.7 in the albumin group and 1206.0 +/- 522.5-1273.5 +/- 444.8 pg mL(-1); P = 0.22 in the noradrenaline group). The cost of noradrenaline treatment was significantly lower when compared with that of albumin (P < 0.001).

Conclusions: Noradrenaline is as effective as albumin in preventing paracentesis-induced circulatory dysfunction in patients with cirrhosis after therapeutic paracentesis, but at a fraction of the cost.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Albumins / economics
  • Albumins / therapeutic use*
  • Aldosterone / blood
  • Blood Volume / drug effects
  • Drug Costs
  • Female
  • Humans
  • Liver Cirrhosis / blood
  • Liver Cirrhosis / therapy*
  • Male
  • Middle Aged
  • Norepinephrine / economics
  • Norepinephrine / therapeutic use*
  • Paracentesis / adverse effects*
  • Pilot Projects
  • Regression Analysis
  • Renin / blood
  • Vasoconstrictor Agents / economics
  • Vasoconstrictor Agents / therapeutic use*

Substances

  • Albumins
  • Vasoconstrictor Agents
  • Aldosterone
  • Renin
  • Norepinephrine