Preservation of nutritional‐status in patients with refractory ascites due to hepatic cirrhosis who are undergoing repeated paracentesis

Abstract Background and Aim: Refractory ascites in liver‐cirrhosis is associated with a poor prognosis. We performed a prospective study to investigate whether aggressive nutritional‐support could improve outcomes in cirrhotic patients. Methods: Cirrhotic patients undergoing serial large‐volume paracentesis for refractory‐ascites were enrolled and randomized into three groups. Group A received post‐paracentesis intravenous nutritional‐support in addition to a balanced oral diet and a late‐evening protein snack, group B received the same oral nutritional‐protocol as the first group but without parenteral support, and group C (the control group) received a low‐sodium or sodium‐free diet. Clinical, anthropometric and laboratory nutritional parameters and biochemical tests of liver and renal function were reported for 12 months of follow‐up. Results: We enrolled 120 patients, who were randomized into three groups of equal size. Patients on the nutritional‐protocol showed better preservation of clinical, anthropometric and laboratory nutritional parameters that were associated with decreased deterioration of liver function compared with patients on the low‐sodium or sodium‐free diet (group C). Groups A and B had lower morbidity and mortality rates than the control group (C). Mortality rates were significantly better in patients who were treated with parenteral‐nutritional‐support than for the other two groups. In patients who were on the nutritional‐protocol, there was a reduction in the requirement of taps for the treatment of refractory ascites. Conclusions: Post‐paracentesis parenteral‐nutritional‐support with a balanced oral diet and an evening protein snack appears to be the best care protocol for patients with liver‐cirrhosis that has been complicated by refractory‐ascites.