Immune-Inflammatory and Metabolic Effects of High Dose Furosemide plus Hypertonic Saline Solution (HSS) Treatment in Cirrhotic Subjects with Refractory Ascites.

Autor:	Tuttolomondo A; U.O.C di Medicina Interna e con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Università degli Studi di Palermo (Italy)., Di Raimondo D; U.O.C di Medicina Interna e con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Università degli Studi di Palermo (Italy)., Bellia C; Sezione di Biochimica Clinica e Medicina Molecolare Clinica, Dipartimento di Biopatologia e Biotecnologie Mediche e Forensi, Università degli Studi di Palermo U.O.C. CoreLab, Azienda Ospedaliera Universitaria Policlinico, Palermo, Italy., Clemente G; U.O.C di Medicina Interna e con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Università degli Studi di Palermo (Italy)., Pecoraro R; U.O.C di Medicina Interna e con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Università degli Studi di Palermo (Italy)., Maida C; U.O.C di Medicina Interna e con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Università degli Studi di Palermo (Italy)., Simonetta I; U.O.C di Medicina Interna e con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Università degli Studi di Palermo (Italy)., Vassallo V; U.O.C di Medicina Interna e con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Università degli Studi di Palermo (Italy)., Di Bona D; School and Chair of Allergology, Dipartimento delle Emergenze e Trapianti d'Organo, University of Bari, Italy., Gulotta E; Dipartimento di Chirurgia Generale e d'Urgenza, Policlinico Universitario 'Paolo Giaccone, University of Palermo, Italy., Ciaccio M; Sezione di Biochimica Clinica e Medicina Molecolare Clinica, Dipartimento di Biopatologia e Biotecnologie Mediche e Forensi, Università degli Studi di Palermo U.O.C. CoreLab, Azienda Ospedaliera Universitaria Policlinico, Palermo, Italy., Pinto A; U.O.C di Medicina Interna e con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), Università degli Studi di Palermo (Italy).
Jazyk:	angličtina
Zdroj:	PloS one [PLoS One] 2016 Dec 12; Vol. 11 (12), pp. e0165443. Date of Electronic Publication: 2016 Dec 12 (Print Publication: 2016).
DOI:	10.1371/journal.pone.0165443
Abstrakt:	Introduction: Patients with chronic liver diseases are usually thin as a result of hypermetabolism and malnutrition expressed by reduced levels of leptin and impairment of other adyponectins such as visfatin. Aims: We evaluated the metabolic and inflammatory effects of intravenous high-dose furosemide plus hypertonic saline solutions (HSS) compared with repeated paracentesis and a standard oral diuretic schedule, in patients with cirrhosis and refractory ascites. Methods: 59 consecutive cirrhotic patients with refractory ascites unresponsive to outpatient treatment. Enrolled subjects were randomized to treatment with intravenous infusion of furosemide (125-250mg⁄bid) plus small volumes of HSS from the first day after admission until 3 days before discharge (Group A, n:38), or repeated paracentesis from the first day after admission until 3 days before discharge (Group B, n: 21). Plasma levels of ANP, BNP, Leptin, visfatin, IL-1β, TNF-a, IL-6 were measured before and after the two type of treatment. Results: Subjects in group A were observed to have a significant reduction of serum levels of TNF-α, IL-1β, IL-6, ANP, BNP, and visfatin, thus regarding primary efficacy endpoints, in Group A vs. Group B we observed higher Δ-TNF-α, Δ-IL-1β, Δ-IL-6, Δ-ANP, Δ-BNP, Δ-visfatin, Δ-Leptin at discharge. Discussion: Our findings underline the possible inflammatory and metabolic effect of saline overload correction in treatment of cirrhosis complications such as refractory ascites, suggesting a possible role of inflammatory and metabolic-nutritional variables as severity markers in these patients. Competing Interests: The authors have declared that no competing interests exist.
Databáze:	MEDLINE
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