Introduction The burden of liver disease is steadily rising in the UK, partly secondary to alcohol misuse. Ascites requiring LVP is one of the major complications leading to hospital admission in patients with cirrhosis. Clear guidelines1 exist regarding correct replacement of albumin and these also state that routine use of blood products to correct coagulopathy is not necessary. However, these are not always consistently applied.
Our aim was to assess the demographic data of patients with cirrhosis undergoing LVP at our centre along with the use of albumin replacement and blood products.
Methods We identified patients who had undergone LVP at our hospital during a 12 month period from October 2010 by reviewing the admission book of our department and by reviewing a list of all the ascitic fluid samples sent to our microbiology department. Case notes for these patients were reviewed and data were collected on patient demographics, aetiology of cirrhosis, use of blood products and human albumin solution (HAS) and volume of ascites drained.
Results 56 LVP were performed on 28 patients. 24 were male, age range 30 – 84 years (median 59 years). Alcohol was either the only or a contributory cause of cirrhosis in 25 (89%) of patients. None had hepatitis B or C virus infection.
5 patients received fresh frozen plasma (14 units in total) and 1 received octaplex® prior to LVP. The total cost was £1024.
8 patients had less than 5L ascites drained and received a total of 19 units of 20% HAS. 16 patients received more than 8g albumin per litre of ascites drained (a total of 31 unnecessary units). The total cost of this was £1400.
The potential cost saving per procedure was £49.47. However data on albumin administration was unavailable for 7 patients and this could be an underestimate.
Conclusion Alcohol is the predominant cause of cirrhosis requiring LVP in our population and working age men constitute the largest proportion. Significant cost savings can be made by avoiding unnecessary blood products and by avoiding excessive use of albumin or administering other fluids when less than 5 litres of ascites are drained. Trusts should ensure relevant protocols are in place.
Disclosure of Interest None Declared
EASL clinical practise guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. Journal of hepatology 2010; 53(3):397–417.
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