COMPARISON OF SPONTANEOUS ASCITES FILTRATION AND REINFUSION WITH TOTAL PARACENTESIS WITH INTRAVENOUS ALBUMIN INFUSION IN CIRRHOTIC-PATIENTS WITH TENSE ASCITES

Objective-To compare the effectiveness and safety of spontaneous ascites filtration and reinfusion and total paracentesis plus intravenous albumin infusion in cirrhotic patients with tense ascites. Design-Randomised trial of the two treatments. Setting-Teaching hospital and district general hospital in Milan. Patients-45 consecutive cirrhotic patients with recurrent tense ascites and urinary sodium excretion rate <20 mmol/day. 35 fulfilled admission criteria and completed the study. 17 received spontaneous ascites filtration and 18 paracentesis plus albumin infusion. Main outcome measures-Body weight; urinary volume; serum and urinary electrolyte, serum fibrinogen, and plasma aldosterone concentrations; and plasma renin activity before the procedure and 24 hours and eight days afterwards. Results-Both procedures were effective in all patients. Weight decreased in both groups and showed no substantial increase after eight days. In patients receiving ascites filtration, values decreased significantly (p<0.01) after 24 hours for platelet count (mean relative change 0.92; 99% confidence interval 0.86 to 0.98) and serum fibrinogen concentration (0.92; 0.88 to 0.98) but returned to pretreatment values after eight days; no laboratory and clinical signs of disseminated intravascular coagulation were noted. Three patients in this group had fever, which receded spontaneously. One patient in each group had dilutional hyponatraemia. Conclusions-Spontaneous ascites filtration and reinfusion is an effective treatment for tense ascites. Reinfusion of the patient's concentrated proteins provides savings without compromising safety.