Midodrine versus Albumin to Prevent Paracentesis Induced Circulatory Dysfunction in Acute on Chronic Liver Failure Patients in the Outpatient Clinic–a Randomized Controlled Trial?,??,???

BackgroundParacentesis-induced circulatory disturbance (PICD) occurs in 12-20% of patients receiving human albumin for large-volume paracentesis and can occur at lower than five liter acute-on-chronic liver failure (ACLF). Albumin infusions are associated with higher costs more prolonged daycare admissions. The aim the study was to determine if oral midodrine-hydrochloride prevent PICD these by increasing mean arterial pressure.MethodsThis open-labeled randomized controlled trial included ACLF undergoing between 3-5 litres who were receive either 20% Human-albumin or 7.5 mg thrice daily three days, 2 hours before paracentesis. MAP recorded daily. primary outcome plasma renin activity (PRA) on day six, a 50% increase from baseline considered PICD.Results183 consecutive screened, 50 arm. Alcohol most common underlying cause cirrhosis. Day 6 PRA non-significantly (p =0.056) midodrine group. absolute change two groups not significant (p=0.093). Four (16%) five(20%) group developed PICD. different arms (p=0.851). Midodrine found be cost-effective.ConclusionsThree days is as effective human-albumin infusion preventing lesser that done large volume