Post-paracentesis circulatory derangements are related to monocyte activation

Authors

  • Daniel E. Carl,

    Corresponding author
    1. Division of Nephrology, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University (VCU), Richmond, VA, USA
    • Correspondence

      Assistant Professor Daniel E. Carl, MD, School of Medicine, Virginia Commonwealth University (VCU), PO Box 980160, Richmond, VA 23298, USA

      Tel: +804 828 9683

      Fax: +804 828 7567

      e-mail: dcarl@mcvh-vcu.edu

    Search for more papers by this author
  • Siddharta Ghosh,

    1. Division of Nephrology, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University (VCU), Richmond, VA, USA
    Search for more papers by this author
  • Jianfeng Cheng,

    1. Division of Gastroenterology and Hepatology, Carolina Medical Center, Charlotte, NC, USA
    Search for more papers by this author
  • Todd W. B. Gehr,

    1. Division of Nephrology, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University (VCU), Richmond, VA, USA
    Search for more papers by this author
  • R. Todd Stravitz,

    1. Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University (VCU), Richmond, VA, USA
    Search for more papers by this author
  • Arun Sanyal

    1. Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University (VCU), Richmond, VA, USA
    Search for more papers by this author

Abstract

Background & Aims

Post-paracentesis circulatory dysfunction is associated with development of hepatorenal syndrome and increased mortality. The impact of large volume paracentesis (LVP) on the 24-h blood pressure (BP) profile is unknown, and the relationship to Na+-retentive and pro-inflammatory cytokines also remains unknown. The aims of this study were to (i) define the effects of LVP with albumin administration on 24-h BP profiles, and (ii) relate changes in BP over time to changes in Na+-retentive hormones, clinical factors and inflammatory cytokines.

Methods

Ten patients undergoing LVP had 24-h ambulatory BP monitoring performed pre- and post-paracentesis. Markers of the innate immune system, bacterial translocation and Na+-retentive hormones were drawn pre- and post-LVP.

Results

Mean arterial pressure (MAP) dropped in nine of the 10 patients in the 24 h following a paracentesis compared to 24 h preceding the procedure (mean drop of 5.5 mmHg, P < 0.005). A mixed effects model was used to define time-covariate interactions in predicting changes in BP profile. Monocyte chemotactic protein-1 (MCP1) was associated with Δsystolic BP (β = −0.011, P < 0.05), Δdiastolic BP (β = −0.012, P < 0.05) and ΔMAP (β = −0.012, P < 0.05). Plasma renin activity was also significantly associated with Δsystolic BP (β = −0.21, P < 0.05). Renal function was also significantly reduced following LVP.

Conclusions

Systolic, diastolic and MAP decreased over 24 h after LVP compared to the 24 h pre-LVP. This drop is related to increases in MCP-1 after LVP. Increased MCP-1, a marker of monocyte activation, was strongly related to changes in BP.

Ancillary