Estudio primario

No clasificado

Usefulness of serum-ascites albumin difference in separating transudative from exudative ascites. Another look.

Año 1988
Autores Mauer K , Manzione NC
Revista Digestive diseases and sciences
Enlaces Pubmed

Este artículo está incluido en 1 Síntesis amplia Síntesis amplias (1 referencia)

Cargando información sobre las referencias
Mostrar resumen

The serum-ascites albumin difference is reported to be superior to ascitic total protein, ascitic-to-serum total protein ratio, lactic dehydrogenase, and ascitic-to-serum lactic dehydrogenase ratio in differentiating between ascites from liver disease and malignant ascites, S-A greater than 1.1 reflecting portal hypertension. We analyzed ascitic fluid from 46 consecutive patients with chronic liver disease, 28 patients with ascites associated with malignancy, 10 patients with right-sided heart failure, 4 patients with hypothyroidism, and 6 patients with miscellaneous causes of ascites to determine if this albumin difference is indeed a more valuable parameter. Analysis of our data confirms with a larger number of patients that the serum-ascites albumin difference is a more reliable indicator of transudative ascites, better termed portal hypertensive ascites. Malignant ascites without liver metastases had features of nonportal hypertensive ascites, and the serum-ascites albumin difference confirms this. The characteristics of malignant ascites associated with liver metastases, however, resemble those of the portal hypertensive ascites complicating liver disease. This new parameter is also helpful in distinguishing congestive heart failure with high protein ascites and portal hypertensive ascitic features from malignant ascites without liver metastases. Of particular note, myxedematous ascitic fluid, classically categorized as exudative, had an S-A greater than 1.1, indicating the possible role of portal hypertension in the development of ascites in these patients.

Mostrar resumen

Estudio primario

No clasificado

The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites.

Año 1992
Revista Annals of internal medicine
Enlaces Pubmed

Este artículo está incluido en 1 Síntesis amplia Síntesis amplias (1 referencia)

Cargando información sobre las referencias
Mostrar resumen

OBJECTIVE:

To compare the serum-ascites albumin gradient to the exudate-transudate concept in the classification of ascites.

DESIGN:

Prospective collection of ascitic fluid data from patients with well-characterized causes of ascites.

SETTING:

Hepatology inpatient and outpatient ward and consult service of a large, urban hospital.

PATIENTS:

A total of 901 paired serum and ascitic fluid samples were collected from consecutive patients with all forms of ascites.

INTERVENTIONS:

None.

MAIN OUTCOME MEASURES:

The utility of the serum-ascites albumin gradient and the old exudate-transudate concept (as defined by ascitic fluid total protein concentration [AFTP]) were compared for their ability in discriminating the cause for ascites formation.

RESULTS:

The albumin gradient correctly differentiated causes of ascites due to portal hypertension from those that were not due to portal hypertension 96.7% of the time. The AFTP, when used as defined in the old exudate-transudate concept, classified the causes of ascites correctly only 55.6% of the time. This resulted in part because the AFTP of most spontaneously infected samples (traditionally expected to be exudates) was low, and the AFTP of most cardiac ascites samples (traditionally expected to be transudates) was high.

CONCLUSIONS:

The exudate-transudate concept should be discarded in the classification of ascites. The serum-ascites albumin gradient is far more useful than the AFTP as a marker for portal hypertension, but the latter remains a useful adjunct in the differential diagnosis of ascites.

Mostrar resumen

Revisión sistemática

No clasificado

Sodium restriction verse sodium unrestriction for cirrhotic ascites: A meta-analysis

Año 2013
Conferencia Gastro 2013 APDW/WCOG Shanghai (Published in: Journal of Gastroenterology and Hepatology 2013;832-833)
Enlaces DOI

Este artículo incluye 10 Estudios primarios 10 Estudios primarios (10 referencias)

Cargando información sobre las referencias
Mostrar resumen

OBJECTIVE:

There has been controversial on whether a sodium restricted diet should be used in cirrhotic patients with ascites in recent years. This meta-analysis was aimed to evaluate the beneficial and harmful effects of sodium unrestriction versus sodium restriction for cirrhotic ascites.

METHODS:

We searched relevant randomized controlled trials (RCTs) from CNKI, CBM, VIP, Wangfang, The Cochrane Library, ISI web of knowledge, PUBMED and EMBASE. We traced the related references; searched literatures by Google Scholar and Scirus; hand searched Chinese Journal of Hepatology (1993–2013), Conference Papers and dissertation; contacted all primary authors regarding missed randomised trials. We made quality assessment of qualified RCTs by the Cochrane Handbook 5.1 and used RevMan 5.1 provided by the Cochrane Collaboration to perform meta-analysis.

RESULTS:

Ten literatures come into Meta analysis with two different sodium dose, containing 948 cases in total.(1) Salt intake was restricted to 21–42 mmol per day: Compared with a sodium restricted diet, a free salt diet shows a statistically significant benefit in shortening the time of ascites disappearance and hospitalisation. Complete ascites disappearance, urine volume and average serum sodium are also in favor of a free salt diet. Hyponatremia and HRS occurred less frequently with a free salt diet. No significant differences were seen in the mortality.(2) Salt intake was restricted to 80 mmol per day: The same as in the first sodium dose group, a free salt diet also shows a statistically significant benefit in shortening the time of ascites disappearance and hospitalisation in comparison with a sodium restricted diet. Complete ascites disappearance, urine volume and average serum sodium are also in favor of a free salt diet. Hyponatremia occurred less frequently with a free salt diet. No significant differences were seen in the mortality and the rates of HRS.

CONCLUSION:

Current evidences indicate that a free salt diet can significantly improve the efficiency for cirrhotic ascites in comparison with a sodium restricted diet. Sodium unrestricted diet has a great advantage in shortening the time of ascites disappearance and hospitalisation, increasing urine volume and average serum sodium and decrease the rate of hyponatremia. The results still need to be proved by high quality RCTs.

Mostrar resumen

Revisión sistemática

No clasificado

TIPS versus paracentesis for cirrhotic patients with refractory ascites

Año 2006
Revista Cochrane Database of Systematic Reviews
Enlaces DOI , Pubmed , PMC

Este artículo está incluido en 1 Síntesis amplia 5 Síntesis amplias (1 referencia)

Este artículo incluye 5 Estudios primarios 5 Estudios primarios (5 referencias)

Cargando información sobre las referencias
Mostrar resumen

BACKGROUND:

Refractory ascites (ie, ascites that cannot be mobilized despite sodium restriction and diuretic treatment) occurs in 10 per cent of patients with cirrhosis. It is associated with substantial morbidity and mortality with a one-year survival rate of less than 50 per cent. Few therapeutic options currently exist for the management of refractory ascites.

OBJECTIVES:

To compare transjugular intrahepatic portosystemic stent-shunts (TIPS) versus paracentesis for the treatment of refractory ascites in patients with cirrhosis.

SEARCH METHODS:

We searched The Cochrane Hepato-Biliary Group Controlled Trials Register (January 2006), the Cochrane Central Register of Controlled Trials in The Cochrane Library (Issue 4, 2005), MEDLINE (1950 to January 2006), EMBASE (1980 to January 2006), CINAHL (1982 to August 2004), and Science Citation Index Expanded (1945 to January 2006).

SELECTION CRITERIA:

We included randomised clinical trials comparing TIPS and paracentesis with or without volume expanders for cirrhotic patients with refractory ascites.

DATA COLLECTION AND ANALYSIS:

We evaluated the methodological quality of the randomised clinical trials by the generation of the allocation section, allocation concealment, and follow-up. Two authors independently extracted data from each trial. We contacted trial authors for additional information. Dichotomous outcomes were reported as odds ratio (OR) with 95% confidence interval (CI).

MAIN RESULTS:

Five randomised clinical trials, including 330 patients, met the inclusion criteria. The majority of trials had adequate allocation concealment, but only one employed blinded outcome assessment. Mortality at 30-days (OR 1.00, 95% CI 0.10 to 10.06, P = 1.0) and 24-months (OR 1.29, 95% CI 0.65 to 2.56, P = 0.5) did not differ significantly between TIPS and paracentesis. Transjugular intrahepatic portosystemic stent-shunts significantly reduced the re-accumulation of ascites at 3-months (OR 0.07, 95% CI 0.03 to 0.18, P < 0.01) and 12-months (OR 0.14, 95% CI 0.06 to 0.28, P < 0.01). Hepatic encephalopathy occurred significantly more often in the TIPS group (OR 2.24, 95% CI 1.39 to 3.6, P < 0.01), but gastrointestinal bleeding, infection, and acute renal failure did not differ significantly between the two groups.

AUTHORS' CONCLUSIONS:

The meta-analysis supports that TIPS was more effective at removing ascites as compared with paracentesis without a significant difference in mortality, gastrointestinal bleeding, infection, and acute renal failure. However, TIPS patients develop hepatic encephalopathy significantly more often.

Mostrar resumen

Estudio primario

No clasificado

The value of ascites adenosine deaminase activity and interferon gamma level in discriminating tuberculous from non-tuberculous ascites.

Año 1994
Revista Journal of the Egyptian Society of Parasitology
Enlaces Pubmed

Este artículo está incluido en 1 Revisión sistemática Revisiones sistemáticas (1 referencia)

Cargando información sobre las referencias
Mostrar resumen

The diagnosis of tuberculous ascites is often difficult because of the subtle clinical clues, poorly discriminative biochemical assays, delayed results of bacteriological studies and hazards of laparoscopy. Therefore, the role of ascites adenosine deaminase (ADA) activity and interferon-gamma (IFN-delta) level in distinguishing tuberculous from other causes of ascites was examined in 50 patients with ascites. Following bacteriologic culture, seventeen (34%) patients were found to have tuberculous ascites; nine (59.9%) of them had also schistosomal hepatic fibrosis (SHF). Therefore, 36% (9 out of 25) of all patients with SHF included in the study, had coexistent peritoneal tuberculosis despite the presence of transudative ascites and unrecognized clinical features. Ascites ADA activity was significantly higher in tuberculous than in other causes of ascites (P < 0.001) regardless of the presence of an underlying liver disease. A cut-off of 28 U/L reached a sensitivity of 94.4% and a specificity of 100%. A direct correlation was found between ascites ADA activity and total proteins in the tuberculous group (r = 0.613) and the only false-negative result occurred in a patient with SHF and low-ascites protein. Ascites IFN-delta level was also significantly higher in tuberculous ascites with or without SHF than in other causes of ascites (P < 0.05). A cut-off of 26 pg/ml reached a sensitivity of 81% and a specificity of 100%. There was no correlation between ascites ADA activity and IFN-delta level in the tuberculous group (r = 0.329). Based on the results of the present study, it can be concluded that tuberculous ascites should be considered as an important cause of ascites particularly in patients with underlying liver disease. Ascites ADA activity was more sensitive than ascites IFN-delta in diagnosing tuberculosis (TB). It has proved to be an easy, rapid, safe and reliable method for routine use in the early diagnosis of tuberculous ascites.

Mostrar resumen

Estudio primario

No clasificado

Chronic pancreatitis with massive ascites.

Año 1968
Revista Digestion
Enlaces DOI , Pubmed

Este artículo está incluido en 1 Síntesis amplia Síntesis amplias (1 referencia)

Cargando información sobre las referencias
Mostrar resumen

Este artículo no tiene resumen

Mostrar resumen

Revisión sistemática

No clasificado

Is salt restriction beneficial in patients with ascites secondary to cirrhosis?

Año 2015
Autores Rada, G , Lustig, N
Reporte Epistemonikos exploratory review. N° 1
Enlaces

Este artículo incluye 4 Estudios primarios 4 Estudios primarios (4 referencias)

Cargando información sobre las referencias
Mostrar resumen

BACKGROUND:

Salt restriction is recommended by many experts and guidelines for the management of ascites in cirrhosis. However, salt restriction is difficult to achieve and excesive salt restriction can increase the risk of hepatorenal syndrome. Epistemonikos ultrarapid reviews are conducted when no systematic reviews are found in Epistemonikos (a database that systematically searchs for systematic reviews in 24 databases), in order to inform clinicians and potential reviewers. Furthermore, there are no ongoing systematic reviews on this topic registered in PROSPERO.

METHODS:

The search was conducted in January 13, 2015. We reviewed 3 clinical practice guidelines addressing management of patients with cirrhosis and ascites (European Association for the Study of the Liver 2010; American Association for the Study of Liver Diseases; Moore et al 2006). We also run a search for primary studies in PubMed using the following strategy combined with the Cochrane Highly Sensitive Search Strategy for identifying randomized trials in MEDLINE (sensitivity-maximizing version [2008 revision]: ("Diet, Sodium-Restricted"[MeSH Terms] OR "Sodium Chloride"[nm] OR salt[ti] OR "salt restriction") AND (cirrho* OR ascit* OR liver OR hepatic*); and we used the 'Related citations' feature in PubMed for each identified study (first 20 hits screened). Finally, we searched for ongoing studies in the WHO International Clinical Trials Registry Platform (ICTRP). We did not attempt to synthesize the studies.

RESULTS:

Four randomised studies were identified (80 to 200 patients). The conclusions of all the guidelines were similar, recommending salt restriction, citing 0 to 2 of the identified studies. None of the guidelines cited the two more recent studies, including the largest one, because they were published afterwards. The individual trials concluded no difference between both alternatives, or superiority of the unrestricted diet.

CONCLUSION:

Current guidelines should update the evidence base for their recommendations on salt restriction in patients with ascites an cirrhosis. A systematic review is urgently needed in this topic.

Mostrar resumen

Estudio primario

No clasificado

Effects of ascites resolution after successful TIPS on nutrition in cirrhotic patients with refractory ascites.

Año 2001
Revista The American journal of gastroenterology
Enlaces DOI , Pubmed

Este artículo está incluido en 1 Síntesis amplia Síntesis amplias (1 referencia)

Cargando información sobre las referencias
Mostrar resumen

OBJECTIVE:

Malnutrition is common in patients with decompensated cirrhosis and refractory ascites. The use of transjugular intrahepatic portosystemic stent shunt (TIPS) is effective in eliminating ascites. The purpose of this study was to investigate the effect of TIPS and resolution of refractory ascites on the nutritional status of patients with decompensated cirrhosis.

METHODS:

Fourteen consecutive patients with refractory ascites and a Pugh score of 9.0+/-0.5 had a TIPS insertion. Biochemical data, resting energy expenditure (REE), total body nitrogen (TBN), body potassium (TBK), body fat (TBF), muscle force (MF), and food intake were recorded before TIPS, and at 3 and 12 months after the procedure.

RESULTS:

Ten patients completed the study. Baseline values for REE, TBN, TBF, MF, and energy intake were below normal at baseline. There was a significant increase in dry weight, TBN, and REE at 3 and 12 months compared with baseline. TBF improved significantly at 12 months. There was a trend toward an increase in energy intake (p = 0.072). There was no change in protein intake, TBK, MF, and Pugh score.

CONCLUSION:

In cirrhotic patients with refractory ascites, resolution of the ascites after TIPS placement resulted in improvement of several nutritional parameters, especially for body composition.

Mostrar resumen

Revisión sistemática

No clasificado

Atraumatic chylous ascites: systematic review on symptoms and causes.

Año 2011
Revista Journal of the American College of Surgeons
Enlaces DOI , Pubmed

Sin referencias

Cargando información sobre las referencias
Mostrar resumen

Este artículo no tiene resumen

Mostrar resumen

Estudio primario

No clasificado

The significance of bloody ascites in patients with cirrhosis.

Año 1984
Autores DeSitter L , Rector WG
Revista The American journal of gastroenterology
Enlaces Pubmed

Este artículo está incluido en 1 Síntesis amplia Síntesis amplias (1 referencia)

Cargando información sobre las referencias
Mostrar resumen

Five percent of cirrhotic patients with ascites in our unit have grossly bloody fluid. Eleven of 32 randomly selected retrospective patients had hepatocellular carcinoma, one tuberculous peritonitis, seven prior trauma, and in 13 the bloody ascites was apparently spontaneous. Five prospectively encountered patients brought the number of cases of spontaneous bloody ascites available for review to 18. Three of these had sudden large intraperitoneal hemorrhages, and bloody ascites in the remaining 15 was incidentally noted at routine diagnostic paracentesis. Bleeding in the former three patients was from a retroperitoneal vein, spontaneous splenic rupture, and an unknown site, respectively. All patients required laparotomy and two died. Ascites red cells in the latter 15 patients may have been from a slowly leaking collateral vein or a hepatic lymphatic and required no treatment. However, the prognosis of these patients was significantly poorer than that of a control group of patients with similar liver tests and clear ascites.

Mostrar resumen