Will Liver Function Tests (LFTs) improve with paracentesis in patients with ascites due to liver cirrhosis?

From the Guidelines

Paracentesis typically does not significantly improve liver function tests (LFTs) in patients with ascites due to liver cirrhosis. While paracentesis effectively removes excess fluid from the peritoneal cavity and provides symptomatic relief from abdominal distension, respiratory discomfort, and early satiety, it does not address the underlying liver dysfunction causing the abnormal LFTs. The procedure primarily manages a symptom (ascites) rather than treating the compromised liver function itself. In some cases, there might be a modest, temporary improvement in certain parameters due to reduced intra-abdominal pressure after fluid removal, but this does not represent true improvement in hepatic function.

Key Points to Consider

• The standard paracentesis procedure involves inserting a needle into the peritoneal cavity, removing fluid, and administering albumin for large volume removals to prevent post-paracentesis circulatory dysfunction 1.
• For meaningful improvement in LFTs, treatment should focus on addressing the underlying cause of cirrhosis, such as alcohol cessation, antiviral therapy for viral hepatitis, weight loss for fatty liver disease, or management of autoimmune conditions, along with standard medical therapy for cirrhosis complications 1.
• Serial large-volume paracentesis has become the mainstay in the management of diuretic-resistant and diuretic-intractable ascites, but it does not correct the underlying mechanisms of ascites formation and has negative effects on systemic hemodynamics and renal function 1.
• The frequency and volume of large-volume paracentesis can be determined from a patient’s sodium intake, and adherence to a sodium-restricted diet should result in ascites accumulation of <4 L/wk 1.

Clinical Implications

• Paracentesis should be performed under strict sterile conditions using disposable sterile materials, and there are no contraindications to large-volume paracentesis other than loculated ascites 1.
• The administration of albumin is the most effective method to prevent circulatory dysfunction after large-volume paracentesis, and it is more effective than other plasma expanders when more than 5 L of ascites are removed 1.
• For patients with severe coagulopathy, caution should be exercised, and large-volume paracentesis should be avoided in the presence of disseminated intravascular coagulation 1.

From the Research

Liver Function Tests (LFTs) Improvement with Paracentesis

• The provided studies do not directly address the improvement of Liver Function Tests (LFTs) with paracentesis in patients with ascites due to liver cirrhosis.
• However, the studies discuss the management and treatment of ascites in liver cirrhosis, including paracentesis, and its effects on patient outcomes 2, 3, 4, 5, 6.
• Paracentesis is mentioned as a treatment option for tense ascites, followed by albumin infusion and diuretic therapy 3, 4, 5.
• The studies emphasize the importance of managing ascites-related complications, such as spontaneous bacterial peritonitis and hepatorenal syndrome, which can impact patient prognosis 2, 3, 4, 5, 6.
• While the studies do not specifically address LFT improvement, they suggest that paracentesis can help alleviate symptoms and improve patient outcomes in those with ascites due to liver cirrhosis 3, 4, 5.

Treatment of Ascites

• The treatment of ascites typically involves sodium restriction and diuretic therapy, with paracentesis considered for tense or refractory ascites 3, 4, 5.
• Large-volume paracentesis followed by plasma volume expansion or transjugular intrahepatic portosystemic shunt placement may be necessary for some patients 4, 5.
• The use of albumin infusion after paracentesis is recommended to prevent circulatory dysfunction and improve patient outcomes 3, 4, 5.

Complications of Ascites

• Spontaneous bacterial peritonitis and hepatorenal syndrome are severe complications of ascites that require prompt diagnosis and treatment 2, 3, 4, 5, 6.
• Antibiotic prophylaxis may be necessary for patients at risk of developing spontaneous bacterial peritonitis, and albumin substitution can help prevent hepatorenal syndrome 3, 5, 6.