Factors associated with the occurrence of adverse events in patients receiving cell-free and concentrated ascites reinfusion therapy

Abstract

Cell-free and concentrated ascites reinfusion therapy (CART) has been considered to be safe as a therapeutic devise for patients with refractory ascites. Adverse events caused, however, develop in a part of patients following paracentesis due to circulatory dysfunction. In the present study, factors associated with occurrence of adverse events after CART procedures were investigated in 20 patients with hepatic ascites who received a total of 61 sessions of the procedures. They were classified into 4 patients experiencing adverse events consisting of 2 patients showing acute kidney injury and 2 patients showing overt hepatic encephalopathy and the remaining 16 patients without adverse events. Demographic characteristics, clinical features, treatment status and laboratory data were compared between both groups. Univariate analysis revealed that blood urea nitrogen (BUN) and estimated glomerular filtration rate (eGFR) at baseline were significant factors associated with the occurrence of adverse events (p = 0.031 and p = 0,044, respectively). Moreover, multivariate analysis revealed that BUN at baseline was the independent risk factors associated with adverse events development (95% CI = 1.012-1.272; p = 0.031). The Spearman's rank correlation coefficient showed a significant correlation between serum BUN level and eGFR at baseline (p = 0.007). In 3 among 4 patients in whom adverse events occurred, serum BUN levels and eGFR at baseline were 30 mg/dl or more and less than 30 ml/minute/1.73 m2, respectively, suggesting that adverse events may develop in patients fulfilling both criteria. In these patients, prophylactic procedures including intravenous administration of albumin concentrates are required to be done to prevent circulatory dysfunction.