Albumin infusions can improve paracentesis-induced circulatory dysfunction (PICD) resulting from large-volume paracentesis (LVP) (> 5l) in patients with cirrhosis, but their effects on PICD induced by acute-on-chronic liver failure (ACLF), a more severe haemodynamic and inflammatory condition, have not been established.
In this randomised, open-label study, 80 adults with ACLF who underwent modest-volume paracentesis (< 5l) received 20% albumin (intervention group) and no albumin or any other fluid (control group). PICD and complications such as hepatic encephalopathy, hyponatraemia, and acute kidney injury were more frequently reported in the control group.
A plasma renin activity (PRA) of 25.15ng/ml on day 3 predicted the development of PICD on day 6. By day 6, the administration of albumin decreased the incidence of PICD, and PRA levels were also lower. In addition, a multivariate logistic regression analysis identified PICD and hepatic vein pressure gradient as predictors of mortality at 28 days.
These data show that the haemodynamic disturbances seen in PICD in patients with ACLF may develop even with lower volumes of ascitic fluid paracentesis in the absence of treatment with albumin, but plasma expansion with this colloid in this specific setting resulted in reduced mortality.