ASCITES - ALBUMIN PREVENTS POSTPARACENTESIS CIRCULATORY DYSFUNCTION IN CIRRHOTICS

Clinical Bottom Line: Albumin is better than dextran or polygeline in preventing postparacentesis circulatory dysfunction in cirrhotics.

Citation/s: Gines A, Fernandez-Esparrach G, Monescillo A, et al. Randomised trial comparing albumin, dextran 70, and polygilene in cirrhotic patients with ascites treated by paracentesis. Gastroenterology 1996;111:1002-10.

Three-part Clinical Question: In a patient with cirrhosis and ascites, will treatment with albumin decrease the risk of postparacentesis circulatory dysfunction compared with other plasma expanders(e.g. dextran, polygeline)?
Search Terms: ascites and albumin in Best Evidence

The Study:
Double-blinded randomised controlled trial with intention-to-treat. pts with cirrhosis and tense ascites, excluded if receiving beta blocker for prophylaxis of variceal bleeding, cancer or resp, cardiac or renal disease
Control group (N = 93; 93 analysed): complete removal of ascites in a single tap and dextran 70 or polygilene
Experimental group (N = 97; 97 analysed): complete removal of ascites in a single tap and albumin (8g/l of ascitic fluid removed)

The Evidence:

Outcome	CER	EER	RRR	ARR	NNT
postparacentesis circulatory dysfunction	.34	.19	44%	0.150	7
95% Confidence Intervals:			8% to 81%	0.026 to 0.274	4 to 38

Comments:

1. NNT for albumin vs polygilene was 6 (95% CI - 3 to 15)
2. postparacentesis circulatory dysfunction was associated with a shorter time to readmission and shorter survival
1. in pts with <5 L of fluid removed, no difference in plasma expanders; in patients with >5 L, albumin was superior

Appraised by: Straus; mar 1998
Kill or Update By: 1999

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