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paracentesis in cirrhotics is associated with increased risk of 30-day readmission

World Journal of Hepatology 2018年第6期10卷 425-432页

作者： Lindsay A Sobotka Rohan M Modi Akshay Vijayaraman A James Hanje Anthony J Michaels Lanla F Conteh Alice Hinton Ashraf El-Hinnawi Khalid Mumtaz Department of Internal Medicine the Ohio State University Wexner Medical Center Division of Gastroenterology Hepatology and Nutrition the Ohio State Wexner Medical Center Division of Biostatistics College of Public Health the Ohio State University Department of Surgery the Ohio State Wexner Medical Center

AIM To determine the readmission rate, its reasons, predictors, and cost of 30-d readmission in patients with cirrhosis and *** A retrospective analysis of the nationwide readmission database(NRD) was performed during the calendar year 2013. All adults cirrhotics with a diagnosis of ascites,spontaneous bacterial peritonitis, or hepatic encephalopathy were identified by ICD-9 codes. Multivariate analysis was performed to assess predictors of 30-d readmission and cost of *** Of the 59597 patients included in this study, 18319(31%) were readmitted within 30 d. Majority(58%) of readmissions were for liver related reasons. paracentesis was performed in 29832(50%) patients on index admission. Independent predictors of 30-d readmission included age 3 Elixhauser comorbidity(OR: 1.13; CI: 1.05-1.22), nonalcoholic cirrhosis(OR: 1.16; CI: 1.10-1.23), paracentesis on index admission(OR: 1.28; CI: 1.21-1.36) and having hepatocellular carcinoma(OR: 1.21; CI: 1.05; 1.39). Cost of index admission was similar in patients readmitted and not readmitted(P-value: 0.34); however cost of care was significantly more on 30 d readmission($30959 ± 762) as compared to index admission($12403 ± 378), P-value: paracentesis are at increased risk of readmission. Risk factors for unplanned readmission should be targeted given these patients have higher healthcare utilization.

关键词： Cirrhosis Readmission rates paracentesis Ascites

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Abdominal paracentesis drainage ameliorates severe acute pancreatitis in rats by regulating the polarization of peritoneal macrophages

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World Journal of Gastroenterology 2018年第45期24卷 5131-5143页

作者： Ruo-Hong Liu Yi Wen Hong-Yu Sun Chun-Yu Liu Yu-Fan Zhang Yi Yang Qi-Lin Huang Jia-Jia Tang Can-Chen Huang Li-Jun Tang PLA Center of General Surgery and Pancreatic Injury and Repair Key Laboratory of Sichuan Province Chengdu Military General HospitalChengdu 610083Sichuan ProvinceChina Third Military Medical University(Army Medical University) Chongqing 400037China Jiaotong Hospital Affiliated with the Sichuan Provincial People’s Hospital Chengdu 611730Sichuan ProvinceChina Department of Ultrasound Chinese Academy of Medical Sciences and Peking Union Medical College HospitalBeijing 100032China

AIM To investigate the role of peritoneal macrophage(PM) polarization in the therapeutic effect of abdominal paracentesis drainage(APD) on severe acute pancreatitis(SAP).METHODS SAP was induced by 5% Na-taurocholate retrograde injection in Sprague-Dawley rats. APD was performed by inserting a drainage tube with a vacuum ball into the lower right abdomen of the rats immediately after the induction of SAP. To verify the effect of APD on macrophages, PMs were isolated and cultured in an environment, with the peritoneal inflammatory environment simulated by the addition of peritoneal lavage in complete RPMI 1640 medium. Hematoxylin and eosin staining was performed. The levels of pancreatitis biomarkers amylase and lipase as well as the levels of inflammatory mediators in the blood and peritoneal lavage were determined. The polarization phenotypes of the PMs were identified by detecting the marker expression of M1/M2 macrophages via flow cytometry, qPCR and immunohistochemical staining. The protein expression in macrophages that had infiltrated the pancreas was determined by Western *** APD treatment significantly reduced the histopathological scores and levels of amylase, lipase, tumor necrosis factor-α and interleukin(IL)-1β, indicating that APD ameliorates the severity of SAP. Importantly, we found that APD treatment polarized PMs towards the M2 phenotype, as evidenced by the reduced number of M1 macrophages and the reduced levels of proinflammatory mediators, such as IL-1β and L-selectin, as well as the increased number of M2 macrophages and increased levels of anti-inflammatory mediators, such as IL-4 and IL-10. Furthermore, in an in vitro study wherein peritoneal lavage from the APD group was added to the cultured PMs to simulate the peritoneal inflammatory environment, PMs also exhibited a dominant M2 phenotype, resulting in a significantly lower level of inflammation. Finally, APD treatment increased the proportion of M2 macrophages and upregulated the e

关键词： Abdominal paracentesis drainage Peritoneal macrophages Polarization Severe acute pancreatitis

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Endoscopic ultrasound and paracentesis in the evaluation of small volume ascites in patients with intra-abdominal malignancies

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World Journal of Gastroenterology 2014年第30期20卷 10219-10222页

作者： Marissa M Montgomery I Michael Leitman Department of Surgery Beth Israel Medical CenterAlbert Einstein College of MedicineNew YorkNY 10003United States

The evaluation of ascites in patients with known or suspected malignancy is a critical aspect of preoperative staging. Endoscopic evaluation by ultrasound of low volume ascites and sampling of the ascitic fluid by endoscopic ultrasound guided paracentesis (EUS-P) is both a sensitive and specific modality for the determination of peritoneal implants, which is not only an important prognostic indicator but a crucial factor in determining treatment strategy. It is common practice to utilize EUS for gastrointestinal malignancies such as pancreatic or gastric masses, with the performance of paracentesis during the same procedure for the purpose of imaging the abnormality and possibly performing fine needle aspiration for biopsy of the neoplasm itself. However, given the ability of EUS-P to adequately sample even minimal ascites, detecting much smaller volumes than traditional computed tomography or magnetic resonance imaging, EUS-P may be a useful modality for the standard metastatic workup of any newly diagnosed or suspected malignancy. In this “Field of Vision” commentary, we discuss the role of EUS-P, including the article by Suzuki et al reporting their experience with EUS-P using an automated spring-loaded needle device. We also review the utility of EUS-P for non-gastrointestinal malignancies, such as ovarian cancer, which has a high incidence of malignant ascites.

关键词： Ascites Malignancy Endoscopic ultrasound paracentesis Fine needle aspiration

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Mannitolum infusion on cirrhotic patients with tense ascites treated by paracentesis

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Chinese Medical Journal 2000年第1期113卷 27-30页

作者：赵江原成英王大骏李星五 Shanxi Province China030012

OBJECTIVE: To investigate whether albumin can be substituted by mannitolum in cirrhotic patients with tense ascites treated by paracentesis. METHODS: Sixty-eight patients admitted to this therapeutic procedure were randomly assigned to receive intravenous albumin (36 patients) and mannitolum (32 patients) infusion. In repeated large-volume paracentesis (3-6 L/day), intravenous albumin 20 g or intravenous 20% mannitolum 250 ml were added. RESULTS: In 24 and 48 hours after paracentesis the mean value of electrolytes, liver and renal functions and various indicators of systemic circulation either in Group 1 or in Group 2 cases were found without changes (P > 0.05). As compared with that before paracentesis, the diameter of spleen vein was increased significantly (P

关键词： paracentesis Adolescent Adult Aged Aged, 80 and over Ascites Female Hexanols Humans Liver Cirrhosis Male Middle Aged Plasma Substitutes

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Ultrasound for Detection of Ascites and for Guidance of the paracentesis Procedure: Technique and Review of the Literature

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International Journal of Clinical Medicine 2014年第20期5卷 1277-1293页

作者： Josh Ennis Geoffrey Schultz Phillips Perera Sarah Williams Laleh Gharahbaghian Diku Mandavia Division of Emergency Medicine Stanford University Medical Center Stanford USA Emergency Professional Services Phoenix USA Department of Emergency Medicine LAC+USC Medical Center Los Angeles USA

Objective: To review the use of ultrasound (US) for the detection of free intraperitoneal fluid (ascites) and for the procedural guidance of the paracentesis procedure. Methods: Two clinical vignettes are presented to review the pertinent diagnostic, management and safety considerations associated with paracentesis. First, US techniques used for the identification of ascites and in the quantification of fluid pockets amenable to aspiration will be discussed. Next, the actual steps required for the performance of US-guided paracentesis will be covered. A review and analysis of the most current literature regarding US and paracentesis then follows. Conclusion: Current literature favors US-guided paracentesis over the traditional blind technique with a significant reduction in both the rate of unsuccessful aspiration of fluid and in the bleeding complications related to this procedure. Use of US for both the diagnostic and therapeutic management of ascites should be advocated as an essential skill for physicians and other health care providers caring for these patients.

关键词： Ultrasound for Detection of Ascites and for Guidance of the paracentesis Procedure: Technique and Review of the Literature

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Large-Volume paracentesis in Patients with Cirrhotic Ascites: Does It Increase the Risk of Serious Bleeding and the Need for Transfusion?

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Open Journal of Blood Diseases 2015年第4期5卷 43-47页

作者： Hind I. Fallatah Unit of Hepatology and Gastroenterology Department of Internal Medicine Faculty of Medicine King Abdulaziz University Jeddah Saudi Arabia

Background: Liver cirrhosis is the most common cause of ascites. For cirrhotic ascites that does not respond to diuretics and salt restriction, large-volume paracentesis is an alternative option. Methods: A retrospective cohort study of patients admitted to the Day care unit at King Abdulaziz University Hospital for therapeutic paracentesis of cirrhotic ascites was performed from March 2013-April 2014. The demographic data and results, including the platelet count, hemoglobin level, prothrombin time (PT), international normalized ratio (INR), serum creatinine, serum albumin, and bilirubin levels, were recorded. We recorded all of the bleeding episodes. Results: We recorded 118 admissions for 13 patients. Nine of them were male (69.2%), and the mean age was 58.6 ± 15.8 years. All patients had a Child-Pugh score of C. The platelet count was lower than normal for 78 admissions (66.1%), and the PT was prolonged for 99 admissions (84%). Three episodes of bleeding occurred in our cohort, all of which were mild and controlled by the local application of pressure. One patient required a platelet transfusion for severe thrombocytopenia, low platelets count was associated with elevated creatinine and low albumin levels (P = 0.014 and 0.003, respectively). Similarly, a prolonged PT was associated with low albumin, high bilirubin, low platelet, and high creatinine levels (P = 0.013, paracentesis is associated with only a small risk of bleeding in patients with cirrhotic ascites, and a transfusion of fresh frozen plasma (FFP) and platelets is not needed for the majority of patients.

关键词： Cirrhosis Ascites paracentesis Ultrasound Prolonged PT

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An automated spring-loaded needle for endoscopic ultrasound-guided abdominal paracentesis in cancer patients

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World Journal of Gastrointestinal Endoscopy 2014年第2期6卷 55-59页

作者： Rei Suzuki Atsushi Irisawa Manoop S Bhutani Takuto Hikichi Tadayuki Takagi Goro Shibukawa Ai Sato Masaki Sato Tsunehiko Ikeda Ko Watanabe Jun Nakamura Srinadh Annangi Kazuhiro Tasaki Katsutoshi Obara Hiromasa Ohira Department of Gastroenterology and Rheumatology Division of Medicine Fukushima Medical University School of Medicine Department of Gastroenterology Fukushima Medical University Aizu Medical Center Department of Gastroenterology Hepatology and Nutrition the University of Texas MD Anderson Cancer Center Department of Endoscopy Fukushima Medical University Hospital Department of Pathology Fukushima Medical University Hospital

AIM: To evaluate the feasibility of using an automatedspring-loaded needle device for endoscopic ultrasound(EUS)-guided abdominal paracentesis(EUS-P) to see if this would make it easier to puncture the mobile and lax gastric wall for ***: The EUS database and electronic medical records at Fukushima Medical University Hospital were searched from January 2001 to April 2011. Patients with a history of cancer and who underwent EUS-P using an automated spring-loaded needle device with a 22-gauge puncture needle were included. The needle was passed through the instrument channel and advanced through the gastrointestinal wall under EUS guidance into the echo-free space in the abdominal cavity and ascitic fluid was collected. The confirmed diagnosis of malignant ascites included positive cytology and results from careful clinical observation for at least 6 mo in patients with negative cytology. The technical success rate, cytology results and complications were ***: We found 11 patients who underwent EUS-P with an automated spring-loaded needle device. In 4 cases, ascites was revealed only with EUS but not in other imaging modalities. EUS-P was done in 7 other cases because there was minimal ascitic fluid and no safe window for percutaneous abdominal aspiration. Ascitic fluid was obtained in all cases by EUS-P. The average amount aspirated was 14.1 mL(range 0.5-38 mL) and that was sent for cytological exam. The etiology of ascitic fluid was benign in 5 patients and malignant in 6. In all cases, ascitic fluid was obtained with the first needle pass. No procedure-related adverse effects ***: EUS-P with an automated springloaded needle device is a feasible and safe method for ascites evaluation.

关键词： Ascetic fluid Malignancy Endoscopic ultrasound paracentesis Fine needle aspiration

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Albumin administration in patients with cirrhosis: Current role and novel perspectives

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World Journal of Gastroenterology 2022年第33期28卷 4773-4786页

作者： Angelo Zambam de Mattos Douglas Alano Simonetto Carlos Terra Alberto Queiroz Farias Paulo Lisboa Bittencourt Tales Henrique Soares Pase Marlon Rubini Toazza Angelo Alves de Mattos Alliance of Brazilian Centers for Cirrhosis Care-the ABC Group Graduate Program in Medicine:Hepatology Federal University of Health Sciences of Porto AlegrePorto Alegre 90050-170Brazil Division of Gastroenterology and Hepatology Mayo ClinicRochesterMN 55902United States Department of Gastroenterology State University of Rio de JaneiroRio de Janeiro 20550-170Brazil Department of Gastroenterology University of São PauloSão Paulo 01246-903Brazil Gastroenterology and Hepatology Unit Hospital PortuguêsSalvador 40130-030Brazil Internal Medicine Unit Irmandade Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90020-090Brazil Gastroenterology and Hepatology Unit Irmandade Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90020-090Brazil 不详

Mortality in cirrhosis is mostly associated with the development of clinical decompensation,characterized by ascites,hepatic encephalopathy,variceal bleeding,or ***,it is important to prevent and manage such ***,the pathophysiology of decompensated cirrhosis was explained by the peripheral arterial vasodilation hypothesis,but it is currently understood that decompensation might also be driven by a systemic inflammatory state(the systemic inflammation hypothesis).Considering its oncotic and nononcotic properties,albumin has been thoroughly evaluated in the prevention and management of several of these decompensating *** are formal evidence-based recommendations from international medical societies proposing that albumin be administered in individuals with cirrhosis undergoing large-volume paracentesis,patients with spontaneous bacterial peritonitis,those with acute kidney injury(even before the etiological diagnosis),and those with hepatorenal ***,there are a few randomized controlled trials and meta-analyses suggesting a possible role for albumin infusion in patients with cirrhosis and ascites(long-term albumin administration),individuals with hepatic encephalopathy,and those with acute-on-chronic liver failure undergoing modest-volume *** studies are necessary to elucidate whether albumin administration also benefits patients with cirrhosis and other complications,such as individuals with extraperitoneal infections,those hospitalized with decompensated cirrhosis and hypoalbuminemia,and patients with hyponatremia.

关键词： Cirrhosis Albumin paracentesis Spontaneous bacterial peritonitis Acute kidney injury Hepatorenal syndrome

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TIPS improves liver transplantation-free survival in cirrhotic patients with refractory ascites:An updated meta-analysis

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World Journal of Gastroenterology 2014年第10期20卷 2704-2714页

作者： Ming Bai Xing-Shun Qi Zhi-Ping Yang Man Yang Dai-Ming Fan Guo-Hong Han Department of Digestive Interventional Radiology State Key Laboratory of Cancer Biology Xijing Hospital of Digestive Diseases Fourth Military Medical University Department of Digestive Interventional Radiology Xijing Hospital of Digestive Diseases Fourth Military Medical University

AIM: To compare the liver transplantation-free (LTF) survival rates between patients who underwent transjugular intrahepatic portosystemic shunts (TIPS) and those who underwent paracentesis by an updated meta-analysis... 详细信息

关键词： Transjugular intrahepatic portosystemic shunt Ascites paracentesis Survival Meta-analysis

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Current approaches to the management of patients with cirrhotic ascites

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World Journal of Gastroenterology 2019年第28期25卷 3738-3752页

作者： Dmitry Victorovich Garbuzenko Nikolay Olegovich Arefyev Department of Faculty Surgery South Ural State Medical University Chelyabinsk 454092 Russia Department of Pathological Anatomy and Forensic Medicine South Ural State Medical University Chelyabinsk 454092 Russia

This review describes current approaches to the management of patients with cirrhotic ascites in relation to the severity of its clinical manifestations. The PubMed database, the Google Scholar retrieval system, the Cochrane Database of Systematic Reviews, and the reference lists from related articles were used to search for relevant publications. Articles corresponding to the aim of the review were selected for 1991-2018 using the keywords:“liver cirrhosis,”“portal hypertension,”“ascites,”“pathogenesis,”“diagnostics,” and “treatment.” Uncomplicated and refractory ascites in patients with cirrhosis were the inclusion criteria. The literature analysis has shown that despite the achievements of modern hepatology, the presence of ascites is associated with poor prognosis and high mortality. The key to successful management of patients with ascites may be the stratification of the risk of an adverse outcome and personalized therapy. Pathogenetically based approach to the choice of pharmacotherapy and optimization of minimally invasive methods of treatment may improve the quality of life and increase the survival rate of this category of patients.

关键词： Liver cirrhosis Ascites Diuretics Large volume paracentesis Peritoneovenous shunting Transjugular intrahepatic portosystemic shunting

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