The effects of therapeutic paracentesis on pro-BNP and troponin in patientes with liver cirrhosis

Objective: Ascites, the most common complication of liver cirrhosis due to portal hypertension, is a significant cause of morbidity and hospitalization. High-volume paracentesis is a frequently used treatment option in resistant refractory ascites. Markers such as BNP, which is released due to the tension of the cardiac muscular structure, and hstroponin as an indicator of cardiac ischemia, are frequently used today and have been shown to increase in liver cirrhosis. In our study, we aimed to prospectively evaluate the effect of dynamic changes with high-volume paracentesis on cardiac preload and ischemia with pro-BNP and hs-troponin. Method: To our study 33 compansated and 25 decompansated who requires large volume paracentesis cirrhosis patients were included. Patients groups excluded from the study in order not to affect the measured pro-BNP and hs-troponin values: history of cardiovascular disease, advanced asthma-COPD, hypothyroidism, stage 3 and above chronic kidney disease, active infection or active complications of cirrhosis, trasplantation history, malignancy including hepatocellular carcinoma, patients under the age of 18 and pregnant. Patients demographic feautures, laboratuary results, levels of proBNP and hs-troponin, in majör therapeutic paracentesis (MTP) group 6th, 48th hour and 7th day proBNP levels and routine biochemical parameters were measured and also hs-troponin levels were measured after 6th hours of MTP. In the MTP group, the amount of paracentesis performed, albumin use, and arterial blood pressure at measurement times were also monitored. The study was conducted with the support of BAP and ethical approval was received. Wilcoxon signed rank test, one of the non-parametric tests, was mainly used in the evaluation of the study results. Findings: As a result of our study, basal pro-BNP and hs-troponin values were found to be significantly higher in the MTP group compared to patientes without ascites. In the MTP group, no statistically significant difference was detected between the basal pro-BNP values and the pro-BNP values measured at the 6th hour, 48th hour and 7th day. There was no significant difference between the hs-troponin value before paracentesis and the hstroponin value measured at 6th hour. Result: Pro-BNP and hs-troponin are correlated with the severity of cirrhosis as prognosis indicators. It has been determined that high-volume paracentesis does not have a significant effect on cardiac preload and cardiac ischemia in patients and may be safe in terms of both cardiac and renal functions.