Abstract | Background and Aims: Methods: In the observation cohort, 230 patients with ACLF (CANONIC criteria) with ascites (≥Grade II) and ACLF ≥Grade I were enrolled. A total of 136 patients (GROUP I) received response-guided (urine sodium >80mmol/day) slow albumin- furosemide infusion ± terlipressin (SAFI ± T), while 94 patients (GROUP II) received standard medical therapy. Twenty-eight-day survival, ascites mobilization (nil or grade 1), and adverse events were noted. In another mechanistic cohort (n = 40), laboratory evidences for improvement in various pathophysiological alterations; gut permeability, endotoxemia, cytokine storm, neutrophil dysfunction, and hemodynamic alterations following SAFI ± T/ Noradrenaline (NAdr) were evaluated. Results: Age, gender, CLIF-C-ACLF, SOFA and MELD scores, ACLF grades and urine sodium were not different between the two groups in the observation cohort. Ascites was mobilized in 102/136 in GROUP I (SAFI ± T) and 23/94 in GROUP II (p < 0.05). Twenty-eight-day survival was significantly higher in GROUP I = 103/136 (75.7%) vs GROUP II = 50/94 (53.2%), (P = <0.001). All those who were unable to reach urine sodium >80 mmol/day died. Four patients in GROUP I developed scrotal gangrene. In the mechanistic cohort, 72% of patients survived with significant improvement in gut permeability, endotoxemia, serum cytokines, neutrophil dysfunction, and hemodynamic alterations. Conclusion: Ascitic fluid mobilization by response-guided SAFI ± T/NAdr therapy improves survival by improving splanchnic and systemic hemodynamics, decreasing gut congestion, gut permeability, and endotoxemia, improving neutrophil functions, and reducing pro-inflammatory cytokines in circulation.
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Authors | Gaurav Pande, Manjunath Hatti, Mohit Kumar Rai, Praveer Rai, Kamlesh Kumar, Krishna Vp, Abhimanyu Nehra, Sudeep Kumar, Smarak Ranjan Rout, Sourav Kumar Mishra, Dinesh Kumar, Umesh Kumar, Prabhaker Mishra, Abdul Majeed, Vivek Anand Saraswat, Kritika Singh, Harshit Singh, Durga Prasanna Misra, Vikas Agarwal |
Journal | Journal of inflammation research
(J Inflamm Res)
Vol. 15
Pg. 5027-5039
( 2022)
ISSN: 1178-7031 [Print] New Zealand |
PMID | 36072778
(Publication Type: Journal Article)
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Copyright | © 2022 Pande et al. |
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