Estudio primario

No clasificado

Characteristics of ascitic fluid in the alcoholic cirrhotic.

Año 1979
Revista Digestive diseases and sciences
Enlaces DOI , Pubmed

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A prospective study was conducted to define the characteristics of ascitic fluid in alcoholic cirrhotics with and without spontaneous bacterial peritonitis (SBP); to correlate these with findings in the peripheral blood; and to determine whether the use of counterimmunoelectrophoresis (CIE) for bacterial antigens will aid in the early diagnosis of SBP. Fifty-one alcoholic cirrhotics had simultaneous determination of their blood or serum and ascitic fluid for the following: WBC and differential count, RBC, LDH, amylase, glucose, total protein, and protein electrophoresis, CIE for pneumococcal andKlebsiella antigens, culture for aerobic and anaerobic bacteria and mycobacteria, and cytology. Of the 51 patients, 2 had SBP (4%). In the other 49 patients (54 sera and ascitic fluids), CIE was positive for pneumococcal antigen in 4/54 sera and in 3/54 ascitic fluids. The mean WBC count in the ascitic fluid was 349. In 4% the count was above 1000, in 18% between 501–1000, and in 32% between 301–500; polymorphs were >30% in 19/54 (32%). Specific gravity was >1.020 in 10/54 (22%), and ascitic fluid total protein of 3.0g/100 ml or above was noted in 24% (12/54). Mean ascitic fluid/serum ratios of total protein, albumin, and globulin were 0.31, 0.33, and 0.30 respectively, and mean ascitic fluid/serum ratios of LDH, amylase, and glucose were 0.54, 0.79, and 1.04. All cultures (except those with SBP) and cytology were negative. Our study confirmed the observation of others, that a significant number of noninfected cirrhotics have increased ascitic fluid WBC, % polymorphs, specific gravity, and total protein concentration. CIE was not helpful in the early diagnosis of SBP.

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Estudio primario

No clasificado

Spironolactone diuresis in patients with cirrhosis and ascites.

Año 1970
Autores Eggert RC
Revista British medical journal
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Increased aldosterone levels with consequent or diuretic-potentiated electrolyte abnormalities are an important consideration when patients with cirrhosis and ascites undergo diuresis. A simple clinical method using the urinary Na/K ratio as a guide to spironolactone dosage is outlined. Patients with a ratio greater than 1 responded well to 100 mg. of spironolactone a day; those when it was one or less responded well to 200 to 1,000 mg. a day.Administration of spironolactone alone (11 patients) or as the main diuretic (three patients) was a safe and effective means of inducing sustained uncomplicated diuresis in all these patients.

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Revisión sistemática

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The transjugular intrahepatic portosystemic shunt for the management of cirrhotic refractory ascites.

Año 2006
Autores Garcia-Tsao G
Revista Nature clinical practice. Gastroenterology & hepatology
Enlaces DOI , Pubmed

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Cirrhotic ascites results from sinusoidal hypertension and sodium retention, which is secondary to a decreased effective arterial blood volume. Transjugular intrahepatic portosystemic shunt (TIPS) placement is currently indicated in cirrhotic patients with refractory ascites who require large-volume paracentesis (LVP) more than two or three times per month. TIPS placement is associated with normalization of sinusoidal pressure and a significant improvement in urinary sodium excretion that correlates with suppression of plasma renin activity, which is, itself, indicative of an improvement in effective arterial blood volume. Compared with serial LVP, placement of an uncovered TIPS stent is more effective at preventing ascites from recurring; however, increased incidence of hepatic encephalopathy and shunt dysfunction rates after TIPS placement are important issues that increase its cost. Although evidence suggests that TIPS placement might result in better patient survival, this needs to be confirmed, particularly in light of the development of polytetrafluoroethylene-covered stents. Favorable results apply to centers experienced in placing the TIPS, with the aim being to decrease the portosystemic gradient to <12 mmHg but >5 mmHg. This article reviews the pathophysiologic basis for the use of a TIPS in patients with refractory ascites, the results of controlled trials comparing TIPS placement (using uncovered stents) versus LVP, and a systematic review of predictors of death after TIPS placement for refractory ascites.

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Revisión sistemática

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Derivación Portosistémica Intrahepática Transyugular en la ascitis refractaria: un meta-análisis.

Traducción colaborativa
Año 2005
Revista Liver international : official journal of the International Association for the Study of the Liver
Enlaces DOI , Pubmed

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La Derivación Portosistémica Intrahepática Transyugular (DPIT) es un tratamiento para la ascitis refractaria que es más eficaz que la paracentesis de gran volumen (PGV), sin embargo, la magnitud de su efecto en términos de control de la ascitis, encefalopatía y sobrevida no ha sido establecida.

OBJETIVO:

Este meta-análisis compara DPIT con PGV en términos de control de la ascitis a los 4 y 12 meses, encefalopatía y sobrevida a 1 y 2 años.

RESULTADOS:

Se incluyeron cinco ensayos controlados randomizados involucrando 330 pacientes. En el grupo DPIT, el control de la ascitis se logró con mayor frecuencia a los 4 meses (66% vs 23.8%, diferencia de medias: 41.4%, intervalo de confianza 95% (IC): 29.5-53.2%, P < 0,001) y 12 meses (54.8% vs 18.9%, diferencia de medias: 35%, IC 95%: 24.9-45.1%, P < 0,001), mientras que la encefalopatía fue mayor (54.9% vs 38.1%, diferencia de medias: 17%, IC 95%: 7.3-26.6% , P < 0,001). Las sobrevidas a 1 año (61.7% vs 56.5%, diferencia de medias: 3.2%, IC 95%: -14.7 a 21.9%) y a 2 años (50% vs 42.8%, diferencia de medias: 6.8%, IC 95%: -10 a 23.6%) no fueron significativamente diferentes.

CONCLUSIÓN:

La DPIT es un tratamiento más eficaz para la ascitis refractaria que la PGV. Sin embargo, la DPIT aumenta la encefalopatía y no mejora la sobrevida.

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Estudio primario

No clasificado

Dilutional hyponatremia in patients with cirrhosis and ascites.

Año 2002
Revista Archives of internal medicine
Enlaces Pubmed

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OBJECTIVES:

To analyze the predisposing factors, modifications of vasoactive systems, and prognosis of patients with cirrhosis and hyponatremia.

PATIENTS AND METHODS:

Fifty-four patients with hyponatremia (serum sodium level of <130 mEq/L after 5 days of hyponatremic diet and no diuretic therapy). Twenty cirrhotic patients served as controls. We measured plasma renin activity and levels of plasma aldosterone, norepinephrine, and antidiuretic hormone. Follow-up identified the development of hepatorenal syndrome and death.

RESULTS:

A higher percentage of patients with hyponatremia had decreased liver size, higher levels of plasma renin activity, and higher serum concentrations of aldosterone and norepinephrine. Renal insufficiency was detected in 31 of them (57%). Precipitating factors (hemorrhage or infections) were detected in 27 patients (50%). Incidence of hepatorenal syndrome and death were higher in patients with spontaneous development of hyponatremia (n = 23 [85%] and n = 25 [93%], respectively) than in patients with precipitating factors (n = 15 [56%] and n = 12 [44%], respectively) and cirrhotic controls (n = 1 [5%] and n = 5 [25%], respectively) (P<.001). Results of multivariate analysis showed that Child-Pugh index, presence of hepatocarcinoma, and serum concentration of urea were associated with mortality. After excluding those patients with kidney failure at the time of admission, only Child-Pugh index and norepinephrine concentrations were independent predictors of mortality.

CONCLUSIONS:

Hyponatremia is an alteration in patients with advanced liver disease. Although survival is significantly reduced in patients with spontaneous development of hyponatremia, a reduced sodium concentration cannot be considered as a independent predictor of the risk for death.

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Revisión sistemática

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Tuberculosis peritoneal en una paciente con ascitis y masa anexial. Reporte de caso

Traducción oficial
Año 2006
Revista Rev. colomb. obstet. ginecol
Enlaces Virtual Health Library

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Objetivo: presentar el cuadro clínico y de laboratorio de una paciente con tuberculosis peritoneal. La tuberculosis puede afectar diferentes órganos con presentaciones clínicas que simulan otras patologías. Presentamos el caso de una paciente con ascitis y masa anexial diagnosticada por tomografía y con CA 125 elevado. Se realizó laparotomía exploradora con la impresión diagnóstica de tumor de ovario, encontrando adherencias y siembras peritoneales. La patología informó inflamación granulomatosa crónica compatible con tuberculosis.

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Revisión sistemática

No clasificado

Uncovered transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis.

Año 2005
Revista Gastroenterology
Enlaces DOI , Pubmed

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BACKGROUND & AIMS:

Several trials showed that uncovered transjugular intrahepatic portosystemic shunt (TIPS) is superior to paracentesis for the control of refractory ascites. However, the results for encephalopathy and mortality were not consistent across trials. We performed a systematic review of randomized controlled trials of TIPS for refractory ascites to assess the overall treatment effects and to explore potential reasons of heterogeneity.

METHODS:

Pertinent studies were retrieved trough MEDLINE (1968-2004), EMBASE (1986-2004), the Cochrane Library (2004;4), and reference lists of key articles. Outcome measures were recurrence of ascites, encephalopathy, and mortality. Metaregression analysis was used to explore heterogeneity.

RESULTS:

Five trials were identified including 330 patients. Successful TIPS placement ranged from 77% to 100% and portosystemic pressure gradient reduction ranged from 6.0 to 14.0 mm Hg. Metaregression analysis showed that bilirubin levels and successful TIPS placement rates were associated significantly with log-odds ratio for death after TIPS, explained heterogeneity of trials for mortality, and suggested an outlier trial. After exclusion of the outlier trial, pooled odds ratios for recurrence of ascites with TIPS was .14 (confidence interval, .07-.27), for encephalopathy was 2.26 (confidence interval, 1.35-3.76), and for mortality was .74 (confidence interval, .40-1.37), without any significant heterogeneity.

CONCLUSIONS:

Uncovered TIPS is significantly better than paracentesis for control of refractory ascites. Although it increases encephalopathy, it also is associated with a trend toward improvement of survival. Future TIPS trials should select patients on the basis of bilirubin levels and predictors of the risk for post-TIPS encephalopathy, and assess costs and quality of life.

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Revisión sistemática

No clasificado

Meta-analysis on integrative medicine for the treatment of malig- nant ascites: a comparative study

Año 2015
Autores Li Y , Lou Y , Deng B , Jia L
Revista Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan / sponsored by All-China Association of Traditional Chinese Medicine, Academy of Traditional Chinese Medicine
Enlaces DOI , Pubmed

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OBJECTIVE:

To compare the efficacy of integrated Chinese and Western Medicine with that of only Western Medicine for the treatment of malignant ascites.

METHODS:

All randomized controlled trials (January 2004 to March 2013) from the China National Knowledge Infrastructure Database, Chinese Biomedical Literature Database, and Wanfang Database were searched with keywords. Meta-analysis was conducted by combining the odds ratios of the individual studies. Review Manager 5.0 was used for the analysis.

RESULTS:

One thousand one hundred and fifty-six patients from 19 randomized controlled trails were included. Of them, 630 patients were treated with integrated Chinese and Western Medicine (the integrative group), and 526 patients were treated with Western Medicine alone (the control group). The Meta-analysis showed that the total effective rate was 78.73% in the integrated group, and 59.13% in the control group. The effective percentage was significantly higher in the integrative group than that of the control group [OR = 2.85, 95% CI (2.16, 3.74), P < 0.01].

CONCLUSION:

The short-term curative effect in the integrative group was better than that in the control group. Integrative medicine may be beneficial for malignant ascites.

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Revisión sistemática

No clasificado

Effects of midodrine for patients with ascites Due to cirrhosis: systematic review with meta-analysis.

Año 2016
Autores Guo TT , Yang Y , Song Y , Ren Y , Liu ZX , Cheng G
Revista Journal of digestive diseases
Enlaces DOI , Pubmed

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AIM:

Midodrine was found to improve systemic and renal hemodynamics in patients with cirrhotic ascites. Recently, this discovery has received research interest. Clinical trials on midodrine for this indication have demonstrated conflicting results. The aim of this study is to evaluate the effects of midodrine on cirrhotic ascites through a meta-analysis and systematic review.

METHODS:

We searched PubMed (January 1966 to December 2014), EMBASE (January 1966- December 2014), the Cochrane Library (Issue 11, 2014), ScienceDirect (January 1966- December 2014), and the China National Knowledge Infrastructure (January 1979- December 2014) using the search terms "midodrine", "cirrhosis", "ascites" and "paracentesis" and searched for all relevant randomized controlled trials using midodrine for treatment of cirrhotic ascites.

RESULTS:

Ten trials with a total of 462 patients were included. As a novel therapy for cirrhotic ascites, midodrine was not found to improve survival (OR=0.81; 95%CI 0.23 to 2.91); on the other hand, it may improve response rates (OR=3.36; 95%CI 1.47 to 7.69) and reduce plasma renin activity (MD=-3.10; 95%CI -5.37 to -0.84). When midodrine was used as an alternative to albumin in large volume paracentesis, the mortality was higher for midodrine than for albumin (OR=10.76; 95%CI 1.35 to 85.97). However, midodrine and albumin were similarly associated with the development of paracentesis-induced circulatory dysfunction (OR=1.69; 95%CI 0.43 to 6.72).

CONCLUSIONS:

Based on the results of the meta-analysis, midodrine may have treatment effects on cirrhotic ascites. More adequately powered and well-designed trials are required to assess the extent of the efficacy of midodrine in specifically targeted patients. This article is protected by copyright. All rights reserved.

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Estudio primario

No clasificado

The North American Study for the Treatment of Refractory Ascites.

Año 2003
Revista Gastroenterology
Enlaces DOI , Pubmed

Este artículo está incluido en 6 Revisiones sistemáticas Revisiones sistemáticas (6 referencias)

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BACKGROUND AND AIMS:

The clinical utility of transjugular intrahepatic portosystemic shunts (TIPS) vis-à-vis total paracentesis in the management of refractory ascites is unclear.

METHODS:

A multicenter, prospective, randomized clinical trial was performed in which 109 subjects with refractory ascites were randomized to either medical therapy (sodium restriction, diuretics, and total paracentesis) (n = 57) or medical therapy plus TIPS (n = 52). The principal end points were recurrence of tense symptomatic ascites and mortality.

RESULTS:

A technically adequate shunt was created in 49 of 52 subjects. TIPS plus medical therapy was significantly superior to medical therapy alone in preventing recurrence of ascites (P < 0.001). The total number of deaths in the 2 groups was identical (TIPS vs. medical therapy alone: 21 vs. 21). There were no significant differences in the 2 arms with respect to overall and transplant-free survival. There was a higher incidence of moderate to severe encephalopathy in the TIPS group (20 of 52 vs. 12 of 57; P = 0.058). There were no significant differences in the number of subjects who developed liver failure (7 vs. 3), variceal hemorrhage (5 vs. 8), or acute renal failure (3 vs. 2). There were also no significant differences between the 2 groups in the frequency of emergency-department visits, medically indicated hospitalizations, or quality of life.

CONCLUSIONS:

Although TIPS plus medical therapy is superior to medical therapy alone for the control of ascites, it does not improve survival, affect hospitalization rates, or improve quality of life.

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