Beneficial effects of intravenous albumin infusion on the hemodynamic and humoral changes after total paracentesis

Authors

  • Angelo Luca,

    1. Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic i Provincial, Department of Medicine, University of Barcelona, Barcelona, Spain
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  • Juan C. García-Pagán,

    1. Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic i Provincial, Department of Medicine, University of Barcelona, Barcelona, Spain
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  • Jaume Bosch MD,

    Corresponding author
    1. Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic i Provincial, Department of Medicine, University of Barcelona, Barcelona, Spain
    • Hepatic Hemodynamics Laboratory, Liver Unit, Hospital Clínic i Provincial, C/. Villarroel 170, 08036 Barcelona, Spain
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  • Faust Feu,

    1. Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic i Provincial, Department of Medicine, University of Barcelona, Barcelona, Spain
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  • Wladimiro Jiménez,

    1. Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic i Provincial, Department of Medicine, University of Barcelona, Barcelona, Spain
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  • Angels Ginés,

    1. Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic i Provincial, Department of Medicine, University of Barcelona, Barcelona, Spain
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  • Mercedes Fernández,

    1. Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic i Provincial, Department of Medicine, University of Barcelona, Barcelona, Spain
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  • Angels Escorsell,

    1. Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic i Provincial, Department of Medicine, University of Barcelona, Barcelona, Spain
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  • Vicente Arroyo,

    1. Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic i Provincial, Department of Medicine, University of Barcelona, Barcelona, Spain
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  • Joan Rodés

    1. Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic i Provincial, Department of Medicine, University of Barcelona, Barcelona, Spain
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Abstract

The study investigated the hemodynamic and neuro-humoral effects of albumin infusion after total paracentesis in 18 patients with cirrhosis and tense ascites. Measurements of systemic and splanchnic hemodynamics, and vasoactive neurohumoral systems were performed before and immediately after total paracentesis. The patients were then randomized to receive albumin or not, and hemodynamic and humoral measurements were repeated at 24 hours. Hemodynamic and humoral changes just after paracentesis were similar in patients later randomized to receive albumin infusion or not. Twenty-four hours after total paracentesis, patients not receiving albumin had significant reductions in cardiac index (−13%; P = .005), femoral blood flow (−17%; P = .004), and pulmonary capillary pressure (−16%; P = .02), which were accompanied by significant increases in plasma renin activity (PRA) and plasma aldosterone (PA) and by significant decreases in atrial natriuretic factor (ANF) and plasma sodium. By contrast, there were no significant changes in patients receiving albumin, except for an increase in ANF and a further decrease in PA. In both groups, hepatic venous pressure gradient (HVPG) and azygos blood flow decreased just after paracentesis returning to baseline at 24 hours. This study shows that albumin infusion prevents the impairment in systemic hemodynamics, vasoactive neurohumoral systems, and plasma sodium after a large-volume paracentesis, without detrimental effects on portal pressure and portocollateral blood flow. (Hepatology 1995; 22:753–758.)s

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