Journal article
Assessment of the 2021 AASLD Practice Guidance for Albumin Infusion in Elective Therapeutic Paracentesis: A Regression Discontinuity Design
The American journal of gastroenterology, Vol.119(10), pp.2045-2051
10/2024
DOI: 10.14309/ajg.0000000000002767
PMID: 38501671
Abstract
BACKGROUND The 2021 American Association for the Study of Liver Disease (AASLD) Practice Guidance recommends albumin infusion when removing ≥ 5 liters of ascites to prevent post-paracentesis circulatory dysfunction. However, the optimal criteria and scenarios for initiating albumin infusion subsequent to therapeutic paracentesis (TP) have been subject to limited scientific inquiry. METHODS We conducted a retrospective cohort study at a U.S. academic healthcare center. Participants received elective, outpatient TP between July 2019 and December 2022. Patients with spontaneous bacterial peritonitis, post-TP clinical adjustments, and/or hospitalization were excluded. The institution strictly followed the AASLD Guidance. We employed a sharp regression discontinuity (RD) design to estimate the effect of albumin infusion at the AASLD Guidance-recommended cutoff of 5 liters on serum creatinine and sodium trajectory post-TP.RESULTS Over the study period, 1457 elective TPs were performed on 235 unique patients. Albumin infusion at the threshold of 5 liters of ascites removal reduced serum creatinine levels by 0.046 mg/dl/day (95% CI: 0.003 to 0.116, p-value=0.037) and increased serum sodium levels by 0.35 mEq/L/day (95% CI: 0.15-0.55, p=0.001) compared to those who did not receive albumin infusion. The RD plots indicated worsened serum creatine/sodium levels after draining 3 liters of fluid, approaching levels similar to or worse than with albumin infusion at 5 liters or more. CONCLUSIONS Our RD models supported the 2021 AASLD Guidance with robust estimation of causal effect sizes at the cutoff level of 5 liters. Nevertheless, the findings also highlight the need to further evaluate the efficacy of albumin infusion in patients who undergo elective TP and have 3-5 liters of ascites removed.
Details
- Title: Subtitle
- Assessment of the 2021 AASLD Practice Guidance for Albumin Infusion in Elective Therapeutic Paracentesis: A Regression Discontinuity Design
- Creators
- Tomohiro Tanaka - University of IowaMark Vander Weg - University of IowaMichael P Jones - University of Iowa, Center for Social Science InnovationGeorge Wehby - Iowa City VA Health Care System
- Resource Type
- Journal article
- Publication Details
- The American journal of gastroenterology, Vol.119(10), pp.2045-2051
- DOI
- 10.14309/ajg.0000000000002767
- PMID
- 38501671
- NLM abbreviation
- Am J Gastroenterol
- eISSN
- 1572-0241
- Grant note
- DOI: 10.13039/100000133, name: AHRQ, award: K08 HS029195-01A1
- Language
- English
- Electronic publication date
- 03/19/2024
- Date published
- 10/2024
- Academic Unit
- Statistics and Actuarial Science; Preventive and Community Dentistry; Health Management and Policy; Psychological and Brain Sciences; Economics; Gastroenterology and Hepatology; Biostatistics; Center for Social Science Innovation; Injury Prevention Research Center; Community and Behavioral Health; Internal Medicine
- Record Identifier
- 9984573827402771
Metrics
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