EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis

Möller, Sören

doi:10.1016/j.jhep.2010.05.004

Cited by 1,410 publications

(659 citation statements)

References 237 publications

(370 reference statements)

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“…Ascites is the most common complication of cirrhosis, and about 60% of patients with compensated liver disease develop ascites during the clinical course of the disease [26]. Mortality is approximately 40% at 1 year, and 50% at 2 years [26][27][28][29][30][31]. The most reliable predictors of poor prognosis include hyponatremia, low arterial pressure, increased serum creatinine, and low urine sodium [31].…”

Section: Ascites and Spontaneous Bacterial Peritonitismentioning

confidence: 99%

“…Mortality is approximately 40% at 1 year, and 50% at 2 years [26][27][28][29][30][31]. The most reliable predictors of poor prognosis include hyponatremia, low arterial pressure, increased serum creatinine, and low urine sodium [31]. Ascites usually occurs after development of PH, and is related to an incapacity to excrete an adequate amount of sodium into the urine, leading to a positive sodium balance.…”

Section: Ascites and Spontaneous Bacterial Peritonitismentioning

confidence: 99%

“…Ascites due to cirrhotic portal hypertension can be differentiated from ascites due to other causes by the serum-ascites albumin gradient: if the gradient is greater than or equal to 1.1 g/dl (or 11 g/L), ascites is due to portal hypertension, with an accuracy of 97%. Total ascitic fluid protein concentration should be measured to assess the risk of SBP because patients with a protein concentration of b15 g/L have a increased risk of SBP [31].…”

Section: Ascites and Spontaneous Bacterial Peritonitismentioning

confidence: 99%

“…Moreover, in patients with refractory ascites, the insertion of a transjugular intrahepatic portosystemic shunt (TIPS) should be considered. TIPS placement is not recommended in patients with severe liver failure and/or cardiopulmonary disease [31].…”

Section: Ascites and Spontaneous Bacterial Peritonitismentioning

confidence: 99%

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Clinical implications of the hyperdynamic syndrome in cirrhosis

Licata

Mazzola

Ingrassia

et al. 2014

European Journal of Internal Medicine

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The hyperdynamic syndrome is a late consequence of portal hypertension in cirrhosis. The principal hemodynamic manifestations of the hyperdynamic syndrome are high cardiac output, and increased heart rate and total blood volume, accompanied by reduced total systemic vascular resistance. Pathophysiology involves a complex of humoral and neural mechanisms that can determine hemodynamic changes, and lead to hyperdynamic circulation. In this review we focus our attention on the manifestations of the hyperdynamic syndrome. Some of these are well described and directly related to portal hypertension (varices, ascites, hepatic encephalopathy, and hepatorenal syndrome), while others, such as hepatopulmonary syndrome, portopulmonary hypertension, and cirrhotic cardiomyopathy, are less known as clinical manifestations related to cirrhosis and, therefore, merit further investigation.

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Section: Ascites and Spontaneous Bacterial Peritonitismentioning

confidence: 99%

Section: Ascites and Spontaneous Bacterial Peritonitismentioning

confidence: 99%

Section: Ascites and Spontaneous Bacterial Peritonitismentioning

confidence: 99%

Section: Ascites and Spontaneous Bacterial Peritonitismentioning

confidence: 99%

See 2 more Smart Citations

Clinical implications of the hyperdynamic syndrome in cirrhosis

Licata

Mazzola

Ingrassia

et al. 2014

European Journal of Internal Medicine

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“…In addition, liver transplantation is not possible for all patients with HRS‐1. Current recommended first‐line therapies for HRS‐1 are vasoconstrictors coupled with albumin; among the vasoconstrictors, terlipressin is recommended in clinical practice guidelines as first‐line therapy for HRS‐1, where it is available 10. Terlipressin is a synthetic vasopressin analogue that produces systemic vasoconstriction through its V 1 receptor agonist activity 11.…”

Section: Introductionmentioning

confidence: 99%

Reversal of hepatorenal syndrome type 1 with terlipressin plus albumin vs. placebo plus albumin in a pooled analysis of the OT‐0401 and REVERSE randomised clinical studies

Sanyal

Boyer

Frederick

et al. 2017

Aliment Pharmacol Ther

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SummaryBackgroundThe goal of hepatorenal syndrome type 1 (HRS‐1) treatment is to improve renal function. Terlipressin, a synthetic vasopressin analogue, is a systemic vasoconstrictor used for the treatment of HRS‐1, where it is available.AimTo compare the efficacy of terlipressin plus albumin vs. placebo plus albumin in patients with HRS‐1.MethodsPooled patient‐level data from two large phase 3, randomised, placebo‐controlled studies were analysed for HRS reversal [serum creatinine (SCr) value ≤133 μmol/L], 90‐day survival, need for renal replacement therapy and predictors of HRS reversal. Patients received intravenous terlipressin 1–2 mg every 6 hours plus albumin or placebo plus albumin up to 14 days.ResultsThe pooled analysis comprised 308 patients (terlipressin: n = 153; placebo: n = 155). HRS reversal was significantly more frequent with terlipressin vs. placebo (27% vs. 14%; P = 0.004). Terlipressin was associated with a more significant improvement in renal function from baseline until end of treatment, with a mean between‐group difference in SCr concentration of −53.0 μmol/L (P < 0.0001). Lower SCr, lower mean arterial pressure and lower total bilirubin and absence of known precipitating factors for HRS were independent predictors of HRS reversal and longer survival in terlipressin‐treated patients.ConclusionsTerlipressin plus albumin resulted in a significantly higher rate of HRS reversal vs. albumin alone in patients with HRS‐1. Terlipressin treatment is associated with improved renal function. (ClinicalTrials.gov identifier: OT‐0401, NCT00089570; REVERSE, NCT01143246).

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Daily Low-Volume Paracentesis and Clinical Complications in Patients With Refractory Ascites

et al. 2023

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ImportanceThe potential association of low-volume paracentesis of less than 5 L with complications in patients with ascites remains unclear, and individuals with cirrhosis and refractory ascites (RA) treated with devices like Alfapump or tunneled-intraperitoneal catheters perform daily low-volume drainage without albumin substitution. Studies indicate marked differences regarding the daily drainage volume between patients; however, it is currently unknown if this alters the clinical course.ObjectiveTo determine whether the incidence of complications, such as hyponatremia or acute kidney injury (AKI), is associated with the daily drainage volume in patients with devices.Design, Setting, and ParticipantsThis retrospective cohort study of patients with liver cirrhosis, RA, and a contraindication for a transjugular intrahepatic portosystemic shunt who received either device implantation or standard of care (SOC; ie, repeated large-volume paracentesis with albumin infusion), and were hospitalized between 2012 and 2020 were included. Data were analyzed from April to October 2022.InterventionsDaily ascites volume removed.Main outcomes and MeasuresThe primary end points were 90-day incidence of hyponatremia and AKI. Propensity score matching was performed to match and compare patients with devices and higher or lower drainage volumes to those who received SOC.ResultsOverall, 250 patients with RA receiving either device implantation (179 [72%] patients; 125 [70%] male; 54 [30%] female; mean [SD] age, 59 [11] years) or SOC (71 [28%] patients; 41 [67%] male; 20 [33%] female; mean [SD] age, 54 [8]) were included in this study. A cutoff of 1.5 L/d or more was identified to estimate hyponatremia and AKI in the included patients with devices. Drainage of 1.5 L/d or more was associated with hyponatremia and AKI, even after adjusting for various confounders (hazard ratio [HR], 2.17 [95% CI, 1.24-3.78]; P = .006; HR, 1.43 [95% CI, 1.01-2.16]; P = .04, respectively). Moreover, patients with taps of 1.5 L/d or more and less than 1.5 L/d were matched with patients receiving SOC. Those with taps of 1.5 L/d or more had a higher risk of hyponatremia and AKI compared with those receiving SOC (HR, 1.67 [95% CI, 1.06-2.68]; P = .02 and HR, 1.51 [95% CI, 1.04-2.18]; P = .03), while patients with drainage of less than 1.5 L/d did not show an increased rate of complications compared with those receiving SOC.Conclusions and RelevanceIn this cohort study, clinical complications in patients with RA performing low-volume drainage without albumin infusion were associated with the daily volume drained. Based on this analysis, physicians should be cautious in patients performing drainage of 1.5 L/d or more without albumin infusion.

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EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis

Cited by 1,410 publications

References 237 publications

Clinical implications of the hyperdynamic syndrome in cirrhosis

Clinical implications of the hyperdynamic syndrome in cirrhosis

Reversal of hepatorenal syndrome type 1 with terlipressin plus albumin vs. placebo plus albumin in a pooled analysis of the OT‐0401 and REVERSE randomised clinical studies

Daily Low-Volume Paracentesis and Clinical Complications in Patients With Refractory Ascites

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