Terlipressin versus albumin in paracentesis-induced circulatory dysfunction in cirrhosis: A randomized study


Virendra Singh, Additional Professor, Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India. Email: virendrasingh100@hotmail.com


Background:  Therapeutic paracentesis in patients with cirrhosis induces arterial vasodilatation, causes a decrease in effective arterial blood volume and leads to circulatory dysfunction, which can be prevented by intravenous albumin. However, the use of albumin, being a blood product, is controversial. Recently, terlipressin, a vasoconstrictor, has been successfully used to combat this adverse effect of therapeutic paracentesis. Therefore, the aim of the present study was to investigate the preventive effect of terlipressin on paracentesis-induced circulatory dysfunction in patients with cirrhosis after therapeutic paracentesis and compared with that of intravenous albumin.

Methods:  Forty patients with cirrhosis and tense ascites underwent therapeutic paracentesis with albumin or terlipressin in a randomized pilot study at a tertiary center. Effective arterial blood volume was assessed by measuring plasma renin activity at baseline and at 4–6 days after treatment.

Results:  Effective arterial blood volumes as indicated by plasma renin activity before and 4–6 days after paracentesis did not differ in the two groups (19.15 ± 12.1 to 20.33 ± 12.8 ng/mL per h, P = 0.46 in the albumin group; and 20.11 ± 10.6 to 21.08 ± 10.52 ng/mL per h, P = 0.44 in the terlipressin group). Plasma aldosterone concentrations before and 4–6 days after paracentesis were also similar in both groups (1334.75 ± 1058 to 1440.0 ± 1161 pg/mL, P = 0.06 in the albumin group; and 1473.0 ± 1168 to 1572.29 ± 1182 pg/mL, P = 0.24 in the terlipressin group). Both terlipressin and albumin prevented paracentesis-induced renal impairment in these patients.

Conclusions:  Terlipressin may be as effective as intravenous albumin in preventing paracentesis-induced circulatory dysfunction in patients with cirrhosis after therapeutic paracentesis.