P-65 NOREPINEPHRINE INFUSION AS AN ALTERNATIVE TO ALBUMIN POST LARGE VOLUMEN PARACENTESIS IN CIRRHOTIC PATIENTS

Introduction and Objectives

Albumin is administered to prevent post-paracentesis circulatory dysfunction syndrome (CDS). In many cases, this costly resource is not available. A previous study evaluated the use of norepinephrine in the prevention of CDS with promising results (Singh V et al. J Intern Med. 2006;260(1):62-68.). This study aimed to describe the results obtained in a group of cirrhotic patients with grade III ascites who, due to lack of albumin, were administered norepinephrine infusion as an alternative in post-paracentesis ≥5L.

Materials and Methods

A prospective, descriptive and analytical study was carried out, including cirrhotic patients with grade III ascites who were administered norepinephrine to prevent CDS. Those with infection, baseline kidney injury, recent alcohol consumption and digestive tract bleeding were excluded. Descriptive statistics were performed, with measures of central tendency and dispersion, and the inferential analysis was performed comparing creatinine, NGAL, cystatin C, and sodium at days 0, 3, 6 and 28. It was evaluated if there was development of CDS.

Results

12 patients were included; one presented chest pain without electrocardiographic changes, associated with an increased accidental rate of the infusion (norepinephrine was discontinued); therefore, 11 patients were analyzed; 9(81.8%) men; median age 52.2(range: 39-68) years; 9(81.8%) Child C and 2(18.2%) B; regarding the etiology 8(72.7%) due to alcohol, 2(18.2%) MAFLD, 1(9.1%) HCV. The time in years from the diagnosis of cirrhosis was: 4 (36.4%) less than one year, 6 (54.5%) 1 to 5 years, and 1 (9.1%) more than six years. The median ascites drained was 12.5 L (range: 9-18); the median cost with albumin 8g/L of this drain was $400 USD ($288-576 USD); the cost of the norepinephrine strategy of 2 (2-4 ampoules) with an estimated cost of $12 USD ($12-24 USD). Nobody developed encephalopathy, kidney injury, or CDS. There was no difference between the values ​​determined on days 0, 3, 6 and 28 (p=NS). The results of renal function parameters and renal injury markers are shown in the graphs.

Conclusions

Norepinephrine appears to be a cost-effective alternative where albumin is not available to prevent CDS. Security seems optimal, but trained personnel are required to handle it.