Faculty Collaboration Database

High prevalence of normal serum albumin in NASH patients with ascites: a retrospective analysis. Clin Res Hepatol Gastroenterol 2013 Jun;37(3):246-53

Date

11/28/2012

Pubmed ID

23177511

DOI

10.1016/j.clinre.2012.10.006

Scopus ID

2-s2.0-84878917555 (requires institutional sign-in at Scopus site)   5 Citations

Abstract

BACKGROUND: Ascites usually occurs in the setting of end-stage liver disease and low serum albumin and is associated with increased mortality. However, some patients develop ascites despite normal serum albumin (NSA), when a higher portal pressure and/or enhanced renal sodium retention would be expected. This study investigated the relationship between the hepatic venous pressure gradient (HVPG) and serum albumin in ascitic patients with different etiologies of cirrhosis and mortality.

METHODS: Records of all patients with non-malignant ascites who underwent HVPG measurement from 2005 to 2009 were reviewed.

RESULTS: One hundred and thirty-eight 138 patients met inclusion criteria; 18.8% had NSA. No difference in sodium excretion or diuretic use was noted in patients with and without NSA. NASH patients were more likely to have a NSA (34.2% vs 12.4%; P=0.001) as well as lower HVPG (15 vs 17.9 mmHg; P=0.009) compared to other etiologies. MELD and HVPG predicted overall survival. However, mortality did not differ by disease etiology, though NASH patients had lower CTP (7.6 vs 8.5; P<0.001) and MELD (15.6 vs 18.1; P=0.09) scores, particularly among patients who died.

CONCLUSIONS: In patients with ascites and NSA, there were no increase in HVPG or urinary sodium retention. NASH patients with ascites had lower HVPG and a higher prevalence of NSA. They also had a higher mortality relative to MELD and CTP scores in other patients. In these patients, mechanisms other than portal and oncotic pressures and sodium retention play a role in ascites development, and increase mortality rate when complicated by low albumin.

Author List

Sourianarayanane A, O'Shea RS, Barnes DS, McCullough AJ

Author

Achuthan Sourianarayanane MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adrenergic beta-Antagonists
Ascites
Cohort Studies
Fatty Liver
Female
Humans
Kaplan-Meier Estimate
Liver Circulation
Liver Cirrhosis
Male
Middle Aged
Multivariate Analysis
Retrospective Studies
Serum Albumin
Severity of Illness Index
Sodium
Venous Pressure