ABSTRACT
Patients with liver cirrhosis present an increased susceptibility to the systemic inflammatory response syndrome [SIRS], which is considered the cause of hospital admission in about 10% of patients and is present in about 40% of those admitted for ongoing complications. We tried to assess the prevalence of the SIRS with the possible effects on the course of the disease during hospital stay. Two hundred and three patients with liver cirrhosis were examined and investigated with close monitoring during hospital stay. The main clinical endpoints were death and the development of portal hypertension-related complications. Eighty-one patients met the criteria of SIRS [39.9%]. We found significant correlations between SIRS and jaundice [p = 0.005], bacterial infection [p = 0.008], white blood cell count [p < 0.001], low haemoglobin concentration [p = 0.004], high serum creatinine levels [p < 0.001], high alanine aminotransferase levels [p < 0.001], serum bilirubin levels [p < 0.001], international normalised ratio [p < 0.001], serum albumin levels [p = 0.033], high Child-Pugh score [p < 0.001]. During the follow-up period, 26 patients died [12.8%], 15 developed portal hypertension-related bleeding [7.3%], 30 developed hepatic encephalopathy [14.7%], and 9 developed hepatorenal syndrome type-1 [4.4%]. SIRS showed significant correlations both to death [p < 0.001] and to portal hypertension-related complications [p < 0.001]. The systemic inflammatory response syndrome occurs in patients with advanced cirrhosis and is associated with a bad prognosis
ABSTRACT
Cirrhosis is the commonest cause of ascites accounting for almost 85% of all cases. Approximately 10% of patients with cirrhosis develop diuretic-resistant tense ascites that requires other therapeutic interventions. Large-volume paracentestis with plasma expander infusion, mainly albumin, has been used for the management of ascites in cirrhotic patients. We aimed at investigating whether human albumin can be substituted by a less expensive plasma expander, hydroxyethyl starch 6% following paracentesis. One- hundred and thirty-five patients [60% who cirrhosis and schistosomal perioportal fibrosis combined, 26.7% with postheraptitic cirrhosis and 13.3% with schistosomal periportal librosis] with tense ascites were randomized to treatment by one-session of a nearly-total paracentesis plus intravenous human albumin [68 patients] or hydroxyethyl starch 6% [67 patients]. These were given at a dose of 8 g/l of ascetic fluid removed. The two groups were compared for incidence of complications, recurrence of massive ascites after hospital dismissal and survival rate. Both groups showed no significant changes in renal of hepatic function or serum electrolytes. The incidence of complications following paracentesis was similar in both groups. The number of readmissions during follow up and causes of readmission and survival were also comparable. The effect of paracentesis on the effective intravascular volume was indirectly assessed by plasma rennin activity and plasma aldosterone concentration before treatment, 2 and 6 days after treatment. None of the mean values of these changed significantly in the two groups after paracentesis. Postparacentesis transient hypotension was observed more in the hydroxyethyl starch 6% group than in those treated with albumin [23.9% versus 8.8%, p=0.018]. Hydroxyethyl starch 6% is safe and as effective as human in protecting patients treated with nearly-total paracentesis from developing renal and electrolyte complications. Transient hypotension following paracentesis was, however, commoner in the hydroxeyethyl starch group